Publications by authors named "Umberto Sabatini"

85 Publications

Effects of Ballroom Dance on Physical Fitness and Reaction Time in Experienced Middle-Aged Adults of Both Genders.

Int J Environ Res Public Health 2021 Feb 19;18(4). Epub 2021 Feb 19.

Department of Experimental and Clinical Medicine, "Magna Graecia" University, 88100 Catanzaro, Italy.

Ballroom dance practice might play a pivotal role for successful aging, but its effects could differ depending on dancers' experience level. The aim of this study was to investigate the effects of six months of ballroom dance (three times/w) on physical fitness and reaction time (RT) in 24 middle-aged adults who are experienced dancers (age: 59.4 ± 11.6 years). Body composition, handgrip test (HG), standing long-jump test (SLJ), step test (ST), one-legged stance balance test (OLSB), and RT were assessed before (T) and after six months (T) of dance practice. RT was re-evaluated four months later (T). RT was significantly (p < 0.05) lower at T (221.2 ± 20.3 ms) and T (212.0 ± 21.9 ms) than T (239.1 ± 40,7 ms); no significant differences were found between T and T. No significant differences were observed for all the other parameters between T and T: weight and muscle mass were significantly lower (p < 0.01) in females than in males, and percentage of fat mass was significantly higher (p < 0.01) in females than in males. HG was significantly higher in males than females (p < 0.01). Results suggest that in experienced middle-aged adults of both genders, ballroom dance may positively influence RT, and this result could be maintained for four months.
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http://dx.doi.org/10.3390/ijerph18042036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922230PMC
February 2021

Depletion of circulating IgM memory B cells predicts unfavourable outcome in COVID-19.

Sci Rep 2020 11 30;10(1):20836. Epub 2020 Nov 30.

Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.

Impaired immune responses have been hypothesised to be a possible trigger of unfavourable outcomes in coronavirus disease 2019 (COVID-19). We aimed to characterise IgM memory B cells in patients with COVID-19 admitted to an internal medicine ward in Northern Italy. Overall, 66 COVID-19 patients (mean age 74 ± 16.6 years; 29 females) were enrolled. Three patients (4.5%; 1 female) had been splenectomised and were excluded from further analyses. Fifty-five patients (87.3%) had IgM memory B cell depletion, and 18 (28.6%) died during hospitalisation (cumulative incidence rate 9.26/100 person-week; 5.8-14.7 95% CI). All patients who died had IgM memory B cell depletion. A superimposed infection was found in 6 patients (9.5%), all of them having IgM memory B cell depletion (cumulative incidence rate 3.08/100 person-week; 1.3-6.8 95% CI). At bivariable analyses, older age, sex, number of comorbidities, and peripheral blood lymphocyte count < 1500/µl were not correlated with IgM memory B cell depletion. A discrete-to-marked reduction of the B-cell compartment was also noticed in autoptic spleen specimens of two COVID-19 patients. We conclude that IgM memory B cells are commonly depleted in COVID-19 patients and this correlates with increased mortality and superimposed infections.
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http://dx.doi.org/10.1038/s41598-020-77945-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7705651PMC
November 2020

A New Lung Ultrasound Protocol Able to Predict Worsening in Patients Affected by Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia.

J Ultrasound Med 2020 Nov 6. Epub 2020 Nov 6.

Department of Internal Medicine, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, University of Pavia, Pavia, Italy.

Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can generate severe pneumonia associated with high mortality. A bedside lung ultrasound (LUS) examination has been shown to have a potential role in this setting. The purpose of this study was to evaluate the potential prognostic value of a new LUS protocol (evaluation of 14 anatomic landmarks, with graded scores of 0-3) in patients with SARS-CoV-2 pneumonia and the association of LUS patterns with clinical or laboratory findings.

Methods: A cohort of 52 consecutive patients with laboratory-confirmed SARS-CoV-2 underwent LUS examinations on admission in an internal medicine ward and before their discharge. A total LUS score as the sum of the scores at each explored area was computed. We investigated the association between the LUS score and clinical worsening, defined as a combination of high-flow oxygen support, intensive care unit admission, or 30-day mortality as the primary end point.

Results: Twenty (39%) patients showed a worse outcome during the observation period; the mean LUS scores ± SDs were 20.4 ± 8.5 and 29.2 ± 7.3 in patients without and with worsening, respectively (P < .001). In a multivariable analysis, adjusted for comorbidities (>2), age (>65 years), sex (male), and body mass index (≥25 kg/m ), the association between the LUS score and worsening (odds ratio, 1.17; 95% confidence interval, 1.05 to 1.29; P = .003) was confirmed, with good discrimination of the model (area under the receiver operating characteristic curve, 0.82). A median LUS score higher than 24 was associated with an almost 6-fold increase in the odds of worsening (odds ratio, 5.67; 95% confidence interval, 1.29 to 24.8; P = .021).

Conclusions: Lung ultrasound can represent an effective tool for monitoring and stratifying the prognosis of patients with SARS-CoV-2 pulmonary involvement.
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http://dx.doi.org/10.1002/jum.15548DOI Listing
November 2020

A Phase 1 Randomized Trial of Specific Active α-Synuclein Immunotherapies PD01A and PD03A in Multiple System Atrophy.

Mov Disord 2020 11 3;35(11):1957-1965. Epub 2020 Sep 3.

Université de Toulouse 3, CHU de Toulouse, INSERM, Centre de Reference AMS, Service de Neurologie et de Pharmacologie Clinique, Centre d'Investigation Clinique CIC1436, Réseau NS-Park/FCRIN et Centre of Excellence for Neurodegenerative Disorders (COEN) de Toulouse, Toulouse, France.

Multiple system atrophy (MSA) is a rare and fatal neurodegenerative disease with limited symptomatic treatment options. Aggregation of α-synuclein in oligodendrocytes is believed to be a central mechanism of the neurodegenerative process. PD01A and PD03A are 2 novel therapeutic vaccine candidates containing short peptides as antigenic moieties that are designed to induce a sustained antibody response, specifically targeting pathogenic assemblies of α-synuclein. The objectives of the current study were to evaluate primarily the safety and tolerability of PD01A and PD03A in patients with early MSA. Thirty patients (11 women) were randomized to receive 5 subcutaneous injections of either PD01A (n = 12), PD03A (n = 12), or placebo (n = 6) in this patient- and examiner-blinded, placebo-controlled, 52-week phase 1 clinical trial (ClinicalTrial.gov identifier: NCT02270489). Immunogenicity and clinical scores were assessed as secondary objectives. Twenty-nine patients reported a total of 595 treatment-emergent adverse events (mild or moderate, n = 555; severe, n = 40). Treatment-related adverse events included 190 injection-site reactions typically observed in vaccination trials with similar per-subject incidence in the treatment groups over time. Sustained IgG titers were observed in the PD01A-treated group, and 89% of treated patients developed a PD01-specific antibody response after receiving all injections. Induced antibodies displayed clear reactivity to the α-synuclein target epitope. Titers and antibody responder rate (58%) were lower in the PD03A-treated group. In conclusion, both PD01A and PD03A were safe and well tolerated. PD01A triggered a rapid and long-lasting antibody response that specifically targeted the α-synuclein epitope. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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http://dx.doi.org/10.1002/mds.28218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754431PMC
November 2020

Tracing the mutated HTT and haplotype of the African ancestor who spread Huntington disease into the Middle East.

Genet Med 2020 11 14;22(11):1903-1908. Epub 2020 Jul 14.

Centre for Molecular Medicine Therapeutics, Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.

Purpose: We aimed to determine the origin and genetic characteristics of Huntington disease (HD) in the Middle East.

Methods: We performed genetic and genealogical analyses to establish the ancestral origin of the HTT pathgenic variant from a large kindred from Oman (hereafter called the OM-HD-01 pedigree) by single-nucleotide polymorphism and dense haplotype analysis genotyping.

Results: We traced the oldest ancestry of the largest, eight-generation, OM-HD-01 pedigree (n = 302 subjects, with 54 showing manifest HD) back to sub-Saharan Africa and identified a unique HD haplotype carried by all pedigree members, which consisted of portions of the C6 and C9 haplotypes and was carried by all affected members. Such a unique HD haplotype was of African origin and appeared to be associated with large CAG repeat expansions on average and high frequency of juvenile-onset HD. Three other families from the same area were also identified and found carrying a Caucasian HD haplotype A, also shared by most families of Arab ancestry.

Conclusion: Mutated HTT spread into Middle East with a unique haplotype of African origin, appeared to be associated with juvenile-onset, a HD condition frequently occurring in Black Africans, and may have a significant impact on further development of novel targeted genetic therapies.
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http://dx.doi.org/10.1038/s41436-020-0895-1DOI Listing
November 2020

Neuroplasticity and brain reorganization associated with positive outcomes of multidisciplinary rehabilitation in progressive multiple sclerosis: A fMRI study.

Mult Scler Relat Disord 2020 Jul 6;42:102127. Epub 2020 May 6.

Santa Lucia Foundation IRCCS, Rome, Italy.

Background: Multiple sclerosis (MS) is characterized by a range of symptoms, including motor, sensorimotor and cognitive impairments, that limit the quality of life. A multidisciplinary rehabilitation approach in people affected by multiple sclerosis was recently reported to improve the functional abilities of MS patients in daily activities. The purpose of the study was to assess the effect of multidisciplinary rehabilitation on the whole brain of MS patients by means of functional magnetic resonance imaging (fMRI).

Methods: Thirty individuals affected by MS (49.9 ± 12.1 years; disease duration: 16.0 ± 8.5 years) with a medium-high severity of disease were enrolled. The fMRI examination assessed a range of action-related tasks involving passive movement, mental simulation of action and miming of action triggered by external stimuli, such as object photography. The three tasks were performed using each arm separately. The fMRI acquisitions were performed at T1 (inclusion in the study), T2 (3 months later, at the start of rehabilitation) and T3 (after 3 months of multidisciplinary rehabilitation).

Results: The fMRI results revealed a significant reduction in the activity of brain areas related to task-specific networks as well as the activation of cerebral regions not usually involved in task-specific related network, such as the medial prefrontal area.

Conclusions: The effectiveness of multidisciplinary rehabilitation on activity and participation has been established in previous studies. Our study sheds new light on the effect of such treatment on brain reorganization.
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http://dx.doi.org/10.1016/j.msard.2020.102127DOI Listing
July 2020

Brainstem Posterior Reversible Encephalopathy Syndrome in an Asymptomatic Patient.

Can J Neurol Sci 2020 03;47(2):267-269

Department of Medical and Surgical Sciences, Institute of Neurology, Magna Græcia University, Catanzaro, Italy.

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http://dx.doi.org/10.1017/cjn.2020.2DOI Listing
March 2020

Impact of [Cu][Cu(ATSM)] PET/CT in the evaluation of hypoxia in a patient with Glioblastoma: a case report.

BMC Cancer 2019 Dec 6;19(1):1197. Epub 2019 Dec 6.

Neuroradiology Unit, University "Magna Graecia", Catanzaro, Italy.

Background: Glioblastoma multiform (GBM), a malignant brain tumour, has a very often poor prognosis. The therapeutic approach is represented by surgery followed by radiotherapy and chemotherapy. Hypoxia is a factor that causes a reduction of both radiotherapy and chemotherapy effectiveness in GBM and other cancers. Through the use of [Cu][Cu(ATSM)], a hypoxia-targeting positron emission tomography (PET) radiotracer, is possible to identify the presence of hypoxic areas within a lesion and therefore modulate the therapeutic approach according to the findings.

Case Presentation: In this case report, we observed an increase of radiotracer uptake from early acquisition to late acquisition in hypoxia sites and high correlation between [Cu][Cu(ATSM) PET/CT results and expression of the hypoxia marker HIF-1α.

Conclusions: [Cu][Cu(ATSM) PET/CT represents a valid opportunity to reveal in vivo hypoxic areas in GBM lesion which can guide clinicians on selecting GMB patient's therapeutic scheme.
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http://dx.doi.org/10.1186/s12885-019-6368-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898918PMC
December 2019

Neuroimaging and Neurolaw: Drawing the Future of Aging.

Front Endocrinol (Lausanne) 2019 8;10:217. Epub 2019 Apr 8.

Department of Medical and Surgical Sciences, University of Magna Graecia, Catanzaro, Italy.

Human brain-aging is a complex, multidimensional phenomenon. Knowledge of the numerous aspects that revolve around it is therefore essential if not only the medical issues, but also the social, psychological, and legal issues related to this phenomenon are to be managed correctly. In the coming decades, it will be necessary to find solutions to the management of the progressive aging of the population so as to increase the number of individuals that achieve successful aging. The aim of this article is to provide a current overview of the physiopathology of brain aging and of the role and perspectives of neuroimaging in this context. The progressive development of neuroimaging has opened new perspectives in clinical and basic research and it has modified the concept of brain aging. Neuroimaging will play an increasingly important role in the definition of the individual's brain aging in every phase of the physiological and pathological process. However, when the process involved in age-related brain cognitive diseases is being investigated, factors that might affect this process on a clinical and behavioral level (genetic susceptibility, risks factors, endocrine changes) cannot be ignored but must, on the contrary, be integrated into a neuroimaging evaluation to ensure a correct and global management, and they are therefore discussed in this article. Neuroimaging appears important to the correct management of age-related brain cognitive diseases not only within a medical perspective, but also legal, according to a wider approach based on development of relationship between neuroscience and law. The term neurolaw, the neologism born from the relationship between these two disciplines, is an emerging field of study, that deals with various issues in the impact of neurosciences on individual rights. Neuroimaging, enhancing the detection of physiological and pathological brain aging, could give an important contribution to the field of neurolaw in elderly where the full control of cognitive and volitional functions is necessary to maintain a whole series of rights linked to legal capacity. For this reason, in order to provide the clinician and researcher with a broad view of the brain-aging process, the role of neurolaw will be introduced into the brain-aging context.
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http://dx.doi.org/10.3389/fendo.2019.00217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463811PMC
April 2019

Microstructural changes of normal-appearing white matter in Vascular Parkinsonism.

Parkinsonism Relat Disord 2019 06 1;63:60-65. Epub 2019 Mar 1.

Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy; Neuroscience Center, University "Magna Graecia", Catanzaro, Italy. Electronic address:

Objective: Several evidences demonstrated the role of white matter (WM) lesions in the pathogenesis of Vascular Parkinsonism (VP), a clinical entity characterized by parkinsonism, postural instability, marked gait difficulty and poor response to levodopa. However, the involvement of normal appearing white matter (NAWM) in VP still remains unknown. This study aimed to investigate the microstructural integrity of NAWM in VP compared to Parkinson's disease (PD) and controls using neuroimaging approach.

Methods: Magnetic resonance imaging data were acquired from 50 participants (15 VP, 20 PD and 15 controls). Diffusion tensor imaging (DTI) and Tract-based spatial statistics (TBSS) were performed to assess microstructural NAWM changes. In order to evaluate the relationship between specific fiber tract involvement and clinical picture, diffusion alterations were correlated with clinical features.

Results: Compared to PD patients and controls, significantly reduced fractional anisotropy (FA) and increased mean diffusivity (MD) and radial diffusivity (RD) in NAWM of corpus callosum, internal and external capsule, and corona radiata were present in VP. By contrast, DTI metrics were normal in NAWM-PD and controls. A significant correlation was found between FA and MD of anterior third of corpus callosum and clinical variables (postural instability, freezing-of-gait and symmetry of parkinsonism).

Conclusions: This study improves the knowledge on WM pathology in VP, as our results demonstrate that NAWM damage occurs in VP, but not in PD nor in controls. NAWM damage might relate to clinical picture and suggest that non-clearly-visible WM alterations may contribute to the physiopathology of this vascular disease.
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http://dx.doi.org/10.1016/j.parkreldis.2019.02.046DOI Listing
June 2019

Imaging counterpart of postural instability and vertical ocular dysfunction in patients with PSP: A multimodal MRI study.

Parkinsonism Relat Disord 2019 06 19;63:124-130. Epub 2019 Feb 19.

Neuroscience Center, Magna Graecia University, Catanzaro, Italy; Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy. Electronic address:

Introduction: We investigated the imaging counterpart of two functional domains (ocular motor dysfunction and postural instability) in progressive supranuclear palsy (PSP) patients classified according to the new clinical diagnostic criteria.

Methods: Forty-eight patients with probable PSP-Richardson's syndrome (PSP-RS), 30 with probable PSP-parkinsonism (PSP-P), 37 with Parkinson's disease (PD), and 38 controls were enrolled. For each functional domain, PSP patients were stratified by two certainty levels: vertical supranuclear gaze palsy (O1) and slowness of vertical saccades (O2) for ocular motor dysfunction; early unprovoked falls and tendency to fall on the pull-test for postural instability. Voxel-based morphometry (VBM), whole-brain fractional anisotropy (FA) and MR planimetric measurements were analysed and compared across patient groups.

Results: O1 was present in 64%, and O2 in 36% of all PSP patients. All PSP-RS patients showed early unprovoked falls. TBSS whole-brain analysis revealed that superior cerebellar peduncles (SCPs) were the only structures with significantly lower FA values in PSP-RS compared with PSP-P patients. PSP/O1 patients had lower FA values in midbrain than PSP/O2 patients. By contrast, VBM revealed no differences in grey matter volume between PSP patient groups. MR Planimetric measurements confirmed atrophy of midbrain and SCPs, in line with DTI findings.

Conclusions: Our study demonstrates that SCPs were significantly more damaged in patients with PSP-RS in comparison with PSP-P patients, thus suggesting the role of SCPs in developing postural instability. Midbrain damage was less severe in O2 than in O1 patients, suggesting that the degree of vertical ocular dysfunction reflects the severity of midbrain atrophy.
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http://dx.doi.org/10.1016/j.parkreldis.2019.02.022DOI Listing
June 2019

Refining initial diagnosis of Parkinson's disease after follow-up: A 4-year prospective clinical and magnetic resonance imaging study.

Mov Disord 2019 04 13;34(4):487-495. Epub 2019 Feb 13.

Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.

Background: No prospective study of patients with Parkinson's disease (PD) has investigated the appearance of vertical gaze abnormalities, a feature suggestive of progressive supranuclear palsy (PSP).

Objective: To identify, within a cohort of patients with an initial diagnosis of PD, those who developed vertical gaze abnormalities during a 4-year follow-up, and to investigate the performance of new imaging biomarkers in predicting vertical gaze abnormalities.

Methods: A total of 110 patients initially classified as PD and 74 controls were enrolled. All patients underwent clinical assessment at baseline and every year up to the end of the follow-up. The pons/midbrain area ratio 2.0 and the Magnetic Resonance Parkinsonism Index 2.0 were calculated.

Results: After 4-year follow-up, 100 of 110 patients maintained the diagnosis of PD, whereas 10 PD patients (9.1%) developed vertical gaze abnormalities, suggesting an alternative diagnosis of PSP-parkinsonism. At baseline, the Magnetic Resonance Parkinsonism Index 2.0 was the most accurate biomarker in differentiating PD patients who developed vertical gaze abnormalities from those who maintained an initial diagnosis of PD. At the end of follow-up, both of these biomarkers accurately distinguished PSP-parkinsonism from PD.

Conclusions: Our results demonstrate that a number of patients with an initial diagnosis of PD developed vertical gaze abnormalities during a 4-year follow-up, and the diagnosis was changed from PD to PSP-parkinsonism. In PD patients, baseline Magnetic Resonance Parkinsonism Index 2.0 showed the best performance in predicting the clinical evolution toward a PSP-parkinsonism phenotype, enabling PSP-parkinsonism patients to be identified at the earliest stage of the disease for promising disease-modifying therapies. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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http://dx.doi.org/10.1002/mds.27621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593994PMC
April 2019

In vivo evidence for decreased scyllo-inositol levels in the supplementary motor area of patients with Progressive Supranuclear Palsy: A proton MR spectroscopy study.

Parkinsonism Relat Disord 2019 05 11;62:185-191. Epub 2018 Dec 11.

Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy; Neuroscience Research Centre, Magna Græcia University, Catanzaro, Italy. Electronic address:

Introduction: Several structural and functional neuroimaging studies have shown that the Supplementary Motor Area (SMA) is affected by tau pathology in patients with Progressive Supranuclear Palsy (PSP). The aim of the study was to investigate the biochemical profile of SMA in PSP patients, using proton magnetic resonance spectroscopy (H-MRS).

Methods: Sixteen PSP patients and 18 healthy controls participated in this study. H-MRS was performed by using a Point RESolving Spectroscopy (PRESS) single-voxel sequence implemented on a 3-T scanner. A voxel of 25 × 25 × 15 mm involving the right and left SMA was acquired in all subjects. Peak areas of N-acetyl-aspartate + N-acetyl-aspartyl-glutamate (NAA), creatine with phosphocreatine (Cr), glycerophosphocholine + phosphocholine (Cho), glutamate + glutamine (Glx), glutathione (GSH), myo-Inositol (mI) and Scyllo-Inositol (Scyllo) were calculated using a version 6.3-1K of the fitting program LCModel. Comparative analysis was performed on both absolute concentrations and ratio values relative to Cr.

Results: PSP patients showed a significant decrease in Scyllo concentration and Scyllo/Cr ratio values in SMA, compared to controls, whereas no difference between groups was found for the other ratio values. Of note, the attention and working memory functions were positively related to Scyllo and Scyllo/Cr values in PSP patients.

Conclusions: Our study demonstrates that Scyllo and Scyllo/Cr were significantly reduced in the SMA of PSP patients. Because Scyllo seems to be able to protect against formation of toxic fibrils of amyloid-beta fragments and tau oligomers deposition, these preliminary findings may open new perspectives to investigate Scyllo as a new potential disease-modifying therapy for PSP.
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http://dx.doi.org/10.1016/j.parkreldis.2018.12.008DOI Listing
May 2019

Biological and clinical manifestations of juvenile Huntington's disease: a retrospective analysis.

Lancet Neurol 2018 11 19;17(11):986-993. Epub 2018 Sep 19.

Huntington and Rare Diseases Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy. Electronic address:

Background: Huntington's disease is a rare, neurodegenerative disease caused by an expanded CAG repeat mutation in the huntingtin gene. Compared with adult-onset Huntington's disease, juvenile Huntington's disease (onset ≤20 years) is even rarer and has not been studied extensively. We aimed to further characterise juvenile Huntington's disease by examining the effect of CAG repeat size on disease presentation, progression, and survival.

Methods: We did a retrospective analysis of patients with juvenile Huntington's disease aged 20 years or younger, according to the length of their CAG repeat and who had disabling psychiatric symptoms (with motor symptoms) or motor symptoms alone, and of patients with adult-onset Huntington's disease manifesting aged 30-60 years with 40 or more CAG repeats, from the REGISTRY and ENROLL-HD platforms and from two institutional databases (Lega Italiana Ricerca Huntington Foundation and the Instituto Neurociencias de Buenos Aires and the Sanatorio de la Trinidad Mitre). Patients with psychiatric but no motor symptoms were excluded. We compared symptoms at onset and longitudinally in patients with juvenile Huntington's disease with highly expanded (HE subgroup) or low expansion (LE subgroup) mutations, grouped by hierarchical clustering analysis. We also compared disease progression (longitudinal change in Unified Huntington's Disease Rating Scale-Total Motor Score) and survival of patients with juvenile and adult-onset Huntington's disease.

Findings: We extracted medical records from 580 patients entered into the studies or databases between June 23, 2004, and March 31, 2018, of whom 36 patients met our definition of juvenile Huntington's disease and 197 for adult-onset Huntington's disease. According to caregiver reports, gait disturbance was more often a first presenting symptom in the HE subgroup (eight [80%] of 10 patients) than in the LE subgroup (seven [27%] of 26 patients; p=0·0071), whereas loss of hand dexterity was more common in the LE subgroup (11 [42%] of 26 patients) than in the HE subgroup (0 [0%] of 10 patients; p=0·0160). Compared with the LE subgroup, development delay (0 [0%] in the LE subgroup vs nine [90%] in the HE subgroup; p<0·0001), severe gait impairment (nine [35%] in the LE subgroup vs nine [90%] in the HE subgroup; p=0·0072), and seizures (three [11%] in the LE subgroup vs eight [80%] in the HE subgroup; p<0·0001) prevailed over time in the HE subgroup. Disease progression was more rapid in juvenile Huntington's disease (n=14) than in adult-onset Huntington's disease (n=52; generalised estimating equation model, p=0·0003). Of 121 deceased patients, median survival was shorter in the juvenile Huntington's disease (n=17) cohort than in adult-onset Huntington's disease (n=104) cohort (hazard ratio 2·18 [95% CI 1·08-4·40]; p=0·002).

Interpretation: Patients with HE juvenile Huntington's disease differ clinically from patients with LE juvenile Huntington's disease or adult-onset Huntington's disease, suggesting reclassification of this particularly aggressive form of Huntington's disease might be required.

Funding: Lega Italiana Ricerca Huntington Foundation and IRCCS Ospedale Casa Sollievo della Sofferenza.
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http://dx.doi.org/10.1016/S1474-4422(18)30294-1DOI Listing
November 2018

A new MR imaging index for differentiation of progressive supranuclear palsy-parkinsonism from Parkinson's disease.

Parkinsonism Relat Disord 2018 09 25;54:3-8. Epub 2018 Jul 25.

Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.

Introduction: Differentiating clinically progressive supranuclear palsy-parkinsonism (PSP-P) from Parkinson's disease (PD) may be challenging, especially in the absence of vertical supranuclear gaze palsy (VSGP). The Magnetic Resonance Parkinsonism Index (MRPI) has been reported to accurately distinguish between PSP and PD, yet few data exist on the usefulness of this biomarker for the differentiation of PSP-P from PD.

Methods: Thirty-four patients with PSP-P, 46 with PSP-Richardson's syndrome (PSP-RS), 53 with PD, and 53 controls were enrolled. New consensus criteria for the clinical diagnosis of PSP were used as the reference standard. The MRPI, and a new index termed MRPI 2.0 including the measurement of the third ventricle width (MRPI multiplied by third ventricle width/frontal horns width ratio), were calculated on T1-weighted MR images.

Results: The MRPI differentiated patients with PSP-P from those with PD with sensitivity and specificity of 73.5% and 98.1%, respectively, while the MRPI 2.0 showed higher sensitivity (100%) and similar specificity (94.3%) in differentiating between these two groups. Both biomarkers showed excellent performance in differentiating PSP-P patients with VSGP from those with PD, but the MRPI 2.0 was much more accurate (95.8%) than MRPI in differentiating PSP-P patients with slowness of vertical saccades from PD patients.

Conclusion: The MRPI 2.0 accurately differentiated PSP-P patients from those with PD. This new index was more powerful than MRPI in differentiating PSP patients in the early stage of the disease with slowness of vertical saccades from patients with PD, thus helping clinicians to consolidate the diagnosis based on clinical features, in vivo.
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http://dx.doi.org/10.1016/j.parkreldis.2018.07.016DOI Listing
September 2018

Inspiratory Muscle Rehabilitation in Critically Ill Adults. A Systematic Review and Meta-Analysis.

Ann Am Thorac Soc 2018 06;15(6):735-744

1 Division of Respirology, Department of Medicine, and.

Rationale: Respiratory muscle weakness is common in critically ill patients; the role of targeted inspiratory muscle training (IMT) in intensive care unit rehabilitation strategies remains poorly defined.

Objectives: The primary objective of the present study was to describe the range and tolerability of published methods for IMT. The secondary objectives were to determine whether IMT improves respiratory muscle strength and clinical outcomes in critically ill patients.

Methods: We conducted a systematic review to identify randomized and nonrandomized studies of physical rehabilitation interventions intended to strengthen the respiratory muscles in critically ill adults. We searched the MEDLINE, Embase, HealthSTAR, CINAHL, and CENTRAL databases (inception to September Week 3, 2017) and conference proceedings (2012 to 2017). Data were independently extracted by two authors and collected on a standardized report form.

Results: A total of 28 studies (N = 1,185 patients) were included. IMT was initiated during early mechanical ventilation (8 studies), after patients proved difficult to wean (14 studies), or after extubation (3 studies), and 3 other studies did not report exact timing. Threshold loading was the most common technique; 13 studies employed strength training regimens, 11 studies employed endurance training regimens, and 4 could not be classified. IMT was feasible, and there were few adverse events during IMT sessions (nine studies; median, 0%; interquartile range, 0-0%). In randomized trials (n = 20), IMT improved maximal inspiratory pressure compared with control (15 trials; mean increase, 6 cm HO; 95% confidence interval [CI], 5-8 cm HO; pooled relative ratio of means, 1.19; 95% CI, 1.14-1.25) and maximal expiratory pressure (4 trials; mean increase, 9 cm HO; 95% CI, 5-14 cm HO). IMT was associated with a shorter duration of ventilation (nine trials; mean difference, 4.1 d; 95% CI, 0.8-7.4 d) and a shorter duration of weaning (eight trials; mean difference, 2.3 d; 95% CI, 0.7-4.0 d), but confidence in these pooled estimates was low owing to methodological limitations, including substantial statistical and methodological heterogeneity.

Conclusions: Most studies of IMT in critically ill patients have employed inspiratory threshold loading. IMT is feasible and well tolerated in critically ill patients and improves both inspiratory and expiratory muscle strength. The impact of IMT on clinical outcomes requires future confirmation.
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http://dx.doi.org/10.1513/AnnalsATS.201712-961OCDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137679PMC
June 2018

Increased glutamate + glutamine levels in the thalamus of patients with essential tremor: A preliminary proton MR spectroscopic study.

Parkinsonism Relat Disord 2018 02 28;47:57-63. Epub 2017 Nov 28.

Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neuroimaging Unit, IBFM, National Research Council, Catanzaro, Italy. Electronic address:

Introduction: The aim of this study was to investigate the thalamic biochemical profile in patients with essential tremor (ET), using proton magnetic resonance spectroscopy (H-MRS), and to explore the correlations between clinical and biochemical data.

Methods: Sixteen patients with ET and 14 healthy controls participated in this study. After conventional MR imaging, single-voxel H-MRS (TR = 2000 ms; TE = 28 ms) was performed by using a PROBE-SV system implemented on a 3-T scanner. A voxel of 10 × 10 × 15 mm involving the ventrointermediate (Vim) nucleus was acquired in each thalamus of all subjects. Peak areas of N-acetyl-aspartate + N-acetyl-aspartyl-glutamate (NAA), creatine + phosphocreatine (Cr), glycerophosphocholine + phosphocholine (Cho), and glutamate + glutamine (Glx) were calculated using a version 6.3-1 K of the fitting program LCModel for each voxel. Comparative and correlation analyses were performed on the NAA, Cr, Cho, and Glx concentrations, as well as on the values of the NAA/Cr, a neural density marker, Cho/Cr, a membrane marker, and Glx/Cr, an intracellular neurotransmitter marker.

Results: Patients with ET showed a significant increase in Glx concentration and Glx/Cr ratio values in both thalami, compared to healthy controls, whereas no difference inter-group was found for the other metabolites and NAA/Cr and Cho/Cr ratio values. Of note, the tremor severity was positively related to increased Glx concentrations and Glx/Cr ratio values in ET group.

Conclusions: Our study shows that H-MRS can highlight in vivo metabolic abnormalities in the thalami of ET patients, supporting the evidence that the increase of thalamic glutamatergic transmission can play a role in developing of tremor in ET.
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http://dx.doi.org/10.1016/j.parkreldis.2017.11.345DOI Listing
February 2018

Ictal 18F-FDG PET/MRI in a Patient With Cortical Heterotopia and Focal Epilepsy.

Clin Nucl Med 2017 Oct;42(10):768-769

From the *Neuroimaging Research Unit, Institute of Molecular Bioimaging and Physiology, National Research Council; †Department of Diagnostic Imaging, Nuclear Medicine Unit, ‡Department of Medical and Surgical Sciences, Institute of Neurology, and §Neuroradiology Unit, Magna Graecia University, Catanzaro, Italy.

A 19-year-old man with epilepsy underwent ictal F-FDG PET/MRI, showing a 5 mm heterotopic nodule in the periventricular white matter, adjacent to the frontal horn of the left lateral ventricle (SUVmax, 5.5; glucidic cerebral metabolic rate, 0.317 μmol/mL). A repeated F-FDG PET/MRI, during seizure freedom, showed, at visual analysis, subtle decrease of the nodule metabolism. SUVmax and glucidic cerebral metabolic rate were clearly reduced to 3.7 and 0.226, respectively. Ictal F-FDG PET/MRI could be useful in epilepsy because of the added value of SUVmax and cerebral metabolic rate of glucose analysis to understand the relationship between heterotopy and epilepsy.
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http://dx.doi.org/10.1097/RLU.0000000000001797DOI Listing
October 2017

Thalamic neurometabolic alterations in tremulous Parkinson's disease: A preliminary proton MR spectroscopy study.

Parkinsonism Relat Disord 2017 Oct 28;43:78-84. Epub 2017 Jul 28.

Institute of Neurology, University Magna Græcia, Catanzaro, Italy; Neuroimaging Unit, IBFM, National Research Council, Catanzaro, Italy. Electronic address:

Introduction: The objective of this study was to investigate the thalamic biochemical changes in tremor-dominant Parkinson's disease (tPD) patients in comparison with essential tremor with resting tremor (rET) patients, by using proton MR spectroscopy (H-MRS).

Methods: Fourteen tPD patients, 12 rET patients and 10 controls participated in this study. All patients underwent dopamine transporter single-photon emission computed tomography (DAT-SPECT) with I-ioflupane, and a short-echo single-voxel H-MRS on a 3T scanner. A voxel of 10 × 15 × 10 mm involving the Vim nucleus was acquired in both thalami of all subjects. Peak areas of N-acetyl-aspartate (NAA), creatine (Cr), glycerophosphocholine (Cho), and glutamate (Glu) were measured for each voxel using LCModel. The NAA/Cr, Cho/Cr, and Glu/Cr ratios were then calculated.

Results: DAT-SPECT was abnormal in tPD patients, whereas it was normal in rET patients. Patients with tPD showed a significant reduction of NAA/Cr and Cho/Cr in the thalami compared to rET and healthy controls; whereas there were no significant differences between rET patients and controls. The combination of thalamic NAA/Cr and Cho/Cr ratios showed a 100% accuracy in distinguishing tPD patients from rET patients and controls.

Conclusions: This study provides preliminary evidence that thalamic neurometabolic abnormalities occur in tremor-dominant phenotype of PD, and suggests that H-MRS can help differentiate patients with tPD from those with rET.
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http://dx.doi.org/10.1016/j.parkreldis.2017.07.028DOI Listing
October 2017

The anatomical scaffold underlying the functional centrality of known cortical hubs.

Hum Brain Mapp 2017 10 6;38(10):5141-5160. Epub 2017 Jul 6.

ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France.

Cortical hubs play a fundamental role in the functional architecture of brain connectivity at rest. However, the anatomical scaffold underlying their centrality is still under debate. Certainly, the brain function and anatomy are significantly entwined through synaptogenesis and pruning mechanisms that continuously reshape structural and functional connections. Thus, if hubs are expected to exhibit a large number of direct anatomical connections with the rest of the brain, such a dense wiring is extremely inefficient in energetic terms. In this work, we investigate these aspects on fMRI and DTI data from a set of know resting-state networks, starting from the hypothesis that to promote integration, functional, and anatomical connections link different areas at different scales or hierarchies. Thus, we focused on the role of functional hubs in this hierarchical organization of functional and anatomical architectures. We found that these regions, from a structural point of view, are first linked to each other and successively to the rest of the brain. Thus, functionally central nodes seem to show few strong anatomical connections. These findings suggest an efficient strategy of the investigated cortical hubs in exploiting few direct anatomical connections to link functional hubs among each other that eventually reach the rest of the considered nodes through local indirect tracts. Hum Brain Mapp 38:5141-5160, 2017. © 2017 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/hbm.23721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6867015PMC
October 2017

Resting-state connectivity and modulated somatomotor and default-mode networks in Huntington disease.

CNS Neurosci Ther 2017 Jun 2;23(6):488-497. Epub 2017 May 2.

Huntington and Rare Diseases Unit, IRCSS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy.

Aims: To analyze brain functional connectivity in the somatomotor and default-mode networks (DMNs) of patients with Huntington disease (HD), its relationship with gray matter (GM) volume loss, and functional changes after pridopidine treatment.

Methods: Ten patients and ten untreated controls underwent T1-weighted imaging and resting-state functional magnetic resonance imaging (fMRI); four patients were also assessed after 3 months of pridopidine treatment (90 mg/d). The seed-based functional connectivity patterns from the posterior cingulate cortex and the supplementary motor area (SMA), considered cortical hubs of the DMN and somatomotor networks, respectively, were computed. FMRIB Software Library voxel-based morphometry measured GM volume.

Results: Patients had GM volume decrease in all cortical and subcortical areas of the somatomotor network with preservation of the SMA, and increased somatomotor and DMN connectivity. In DMN structures, functional connectivity impairment preceded volume loss. Pridopidine reduced the intensity of these aberrant connections.

Conclusion: The abnormal connectivity of the somatomotor and DMN observed in HD patients may represent an early dysfunction marker, as it preceded volume loss in DMN. Pridopidine reduced connectivity of these networks in all four treated patients, suggesting that connectivity is sensitive to treatment response.
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http://dx.doi.org/10.1111/cns.12701DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6492661PMC
June 2017

Right sensory-motor functional networks subserve action observation therapy in aphasia.

Brain Imaging Behav 2017 Oct;11(5):1397-1411

IRCCS Fondazione Santa Lucia, Rome, Italy.

Recent studies have shown that the systematic and repetitive observation of actions belonging to the experiential human motor repertoire without verbal facilitation enhances the recovery of verbs in non fluent aphasia. However, it is still an open question whether this approach extends its efficacy also on discourse productivity by improving the retrieval of other linguistic units (i.e. nouns, sentences, content words). Moreover, nothing is known regarding the neural substrates which support the language recovery process due to action observation treatment.In the present study, ten non fluent aphasics were presented with two videoclips (real everyday life context vs. familiar pantomimed context), each video for six consecutive weeks (Monday to Friday, weekend off). During the treatment, they were asked to observe each video and to describe it without verbal facilitation from the therapist. In all patients, language measures were collected before and at the end of treatment. Before and after each treatment condition (real vs. pantomimed context), each subject underwent a resting state fMRI. After the treatment, significant changes in functional connectivity were found in right sensory-motor networks which were accompanied by a significant improvement for the different linguistic units in the real context condition. On the contrary, the language recovery obtained in the pantomimed context did not match any functional modification. The evidence for a recruitment of the sensory-motor cortices during the observation of actions embedded in real context suggests to potentially enhance language recovery in non fluent aphasia through a simulation process related to the sensory-motor properties of actions.
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http://dx.doi.org/10.1007/s11682-016-9635-1DOI Listing
October 2017

Midbrain hemiatrophy and nigral rarefaction in a patient with hemiparkinsonism-hemiatrophy syndrome.

Mov Disord 2016 11 24;31(11):1756-1757. Epub 2016 Sep 24.

Institute of Neurology, University Magna Graecia, Catanzaro, Italy.

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http://dx.doi.org/10.1002/mds.26811DOI Listing
November 2016

Transient effects of tumor location on the functional architecture at rest in glioblastoma patients: three longitudinal case studies.

Radiat Oncol 2016 Aug 17;11(1):107. Epub 2016 Aug 17.

Department of Radiology, Santa Lucia Foundation, Rome, Italy.

Background: The cognitive function of brain tumor patients is affected during the treatment. There is evidence that gliomas and surgery alter the functional brain connectivity but studies on the longitudinal effects are lacking.

Methods: We acquired longitudinal (pre- and post-radiotherapy) resting-state functional magnetic resonance imaging on three selected glioblastoma patients. These cases were selected to study three models: a lesion involving a functional hub within a central system, a lesion involving a peripheral node within a central system and a lesion involving a peripheral node of a non-central system.

Results: We found that, as expected, the tumor lesion affects connections in close vicinity, but when the lesion relates to a functional hub, these changes involve long-range connections leading to diverse connectivity profiles pre- and post-radiotherapy. In particular, a global but temporary improvement in the post-radiotherapy connectivity was obtained when treating a lesion close to a network hub, such as the posterior Cingulate Cortex.

Conclusions: This suggests that this node re-establishes communication to nodes further away in the network. Eventually, these observed effects seem to be transient and on the long-term the tumor burden leads to an overall decline of connectivity following the course of the pathology. Furthermore, we obtained that the link between hubs, such as the Supplementary Motor Area and posterior Cingulate Cortex represents an important backbone by means of which within and across network communication is handled: the disruption of this connection seems to imply a strong decrease in the overall connectivity.
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http://dx.doi.org/10.1186/s13014-016-0683-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989349PMC
August 2016

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

Am J Alzheimers Dis Other Demen 2016 12 14;31(8):618-630. Epub 2016 Jun 14.

Klingberg Lab, Neuroscience Department, Karolinska Institute, Stockholm, Sweden.

Spatial navigation is one of the cognitive functions known to decline in both normal and pathological aging. In the present study, we aimed to assess the neural correlates of the decline of topographical memory in patients with amnestic mild cognitive impairment (aMCI). Patients with aMCI and age-matched controls were engaged in an intensive learning paradigm, lasting for 5 days, during which they had to encode 1 path from an egocentric perspective and 1 path from an allocentric perspective. After the learning period, they were asked to retrieve each of these paths using an allocentric or egocentric frame of reference while undergoing a functional magnetic resonance imaging scan. We found that patients with aMCI showed a specific deficit in storing new topographical memories from an allocentric perspective and retrieving stored information to perform the egocentric task. Imaging data suggest that this general decline is correlated with hypoactivation of the brain areas generally involved in spatial navigation.
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http://dx.doi.org/10.1177/1533317516654757DOI Listing
December 2016

Major Superficial White Matter Abnormalities in Huntington's Disease.

Front Neurosci 2016 23;10:197. Epub 2016 May 23.

Morphology and Morphometry for NeuroImaging Lab, Clinical and Behavioural Neurology Department, IRCCS Fondazione Santa LuciaRome, Italy; Human Studies Department, Libera Università Maria SS. Assunta (LUMSA)Rome, Italy.

Background: The late myelinating superficial white matter at the juncture of the cortical gray and white matter comprising the intracortical myelin and short-range association fibers has not received attention in Huntington's disease. It is an area of the brain that is late myelinating and is sensitive to both normal aging and neurodegenerative disease effects. Therefore, it may be sensitive to Huntington's disease processes.

Methods: Structural MRI data from 25 Pre-symptomatic subjects, 24 Huntington's disease patients and 49 healthy controls was run through a cortical pattern-matching program. The surface corresponding to the white matter directly below the cortical gray matter was then extracted. Individual subject's Diffusion Tensor Imaging (DTI) data was aligned to their structural MRI data. Diffusivity values along the white matter surface were then sampled at each vertex point. DTI measures with high spatial resolution across the superficial white matter surface were then analyzed with the General Linear Model to test for the effects of disease.

Results: There was an overall increase in the axial and radial diffusivity across much of the superficial white matter (p < 0.001) in Pre-symptomatic subjects compared to controls. In Huntington's disease patients increased diffusivity covered essentially the whole brain (p < 0.001). Changes are correlated with genotype (CAG repeat number) and disease burden (p < 0.001).

Conclusions: This study showed broad abnormalities in superficial white matter even before symptoms are present in Huntington's disease. Since, the superficial white matter has a unique microstructure and function these abnormalities suggest it plays an important role in the disease.
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http://dx.doi.org/10.3389/fnins.2016.00197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876130PMC
May 2016

Importance of Multimodal MRI in Characterizing Brain Tissue and Its Potential Application for Individual Age Prediction.

IEEE J Biomed Health Inform 2016 09 27;20(5):1232-9. Epub 2016 Apr 27.

This study presents a voxel-based multiple regression analysis of different magnetic resonance image modalities, including anatomical T1-weighted, T2(*) relaxometry, and diffusion tensor imaging. Quantitative parameters sensitive to complementary brain tissue alterations, including morphometric atrophy, mineralization, microstructural damage, and anisotropy loss, were compared in a linear physiological aging model in 140 healthy subjects (range 20-74 years). The performance of different predictors and the identification of the best biomarker of age-induced structural variation were compared without a priori anatomical knowledge. The best quantitative predictors in several brain regions were iron deposition and microstructural damage, rather than macroscopic tissue atrophy. Age variations were best resolved with a combination of markers, suggesting that multiple predictors better capture age-induced tissue alterations. The results of the linear model were used to predict apparent age in different regions of individual brain. This approach pointed to a number of novel applications that could potentially help highlighting areas particularly vulnerable to disease.
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http://dx.doi.org/10.1109/JBHI.2016.2559938DOI Listing
September 2016

Functional magnetic resonance imaging in disorders of consciousness: preliminary results of an innovative analysis of brain connectivity.

Funct Neurol 2015 Jul-Sep;30(3):193-201

The aim of this preliminary study was to present a new approach for connectivity analysis in patients with severe acquired brain injury (ABI) that overcomes some of the difficulties created by anatomical abnormalities due to the brain injury. Using a data-driven approach, resting-state structural MRI (sMRI) and functional MRI (fMRI) data from three severe ABI patients - two with disorders of consciousness (DOC) and one who had recovered consciousness (non-DOC) - were integrated and analyzed. Parameters extracted from the distribution of the connectivity values, such as mean, standard deviation and skeweness, were considered. The distribution parameters estimated seem to provide an accurate multivariate classification of the considered cases that can be summarized as follows: connectivity in the severe ABI patients with DOC was on average lower than in the severe ABI non-DOC patient and healthy subjects. The dispersion of connectivity values of the severe ABI patients, non-DOC and DOC, was comparable, however the shape of the distribution was different in the non-DOC patient. Eventually, seed-based connectivity maps of the default mode Functional magnetic resonance imaging in disorders of consciousness: preliminary results of an innovative analysis of brain connectivity network show a pattern of increasing disruption of this network from the healthy subjects to non-DOC and DOC patients. Consistent results are obtained using an ICA-based approach..
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610755PMC
http://dx.doi.org/10.11138/fneur/2015.30.3.193DOI Listing
September 2016

Is prosopagnosia a clinical feature of heterotopia? Evidence from a single case report.

Neurol Sci 2016 Jul 22;37(7):1169-73. Epub 2016 Feb 22.

IRCCS Santa Lucia Foundation of Rome, Rome, Italy.

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http://dx.doi.org/10.1007/s10072-016-2514-0DOI Listing
July 2016

Bilateral Transcranial Direct Current Stimulation Language Treatment Enhances Functional Connectivity in the Left Hemisphere: Preliminary Data from Aphasia.

J Cogn Neurosci 2016 May 25;28(5):724-38. Epub 2016 Jan 25.

IRCCS Fondazione Santa Lucia, Rome, Italy.

Several studies have already shown that transcranial direct current stimulation (tDCS) is a useful tool for enhancing recovery in aphasia. However, no reports to date have investigated functional connectivity changes on cortical activity because of tDCS language treatment. Here, nine aphasic persons with articulatory disorders underwent an intensive language therapy in two different conditions: bilateral anodic stimulation over the left Broca's area and cathodic contralesional stimulation over the right homologue of Broca's area and a sham condition. The language treatment lasted 3 weeks (Monday to Friday, 15 sessions). In all patients, language measures were collected before (T0) and at the end of treatment (T15). Before and after each treatment condition (real vs. sham), each participant underwent a resting-state fMRI study. Results showed that, after real stimulation, patients exhibited the greatest recovery not only in terms of better accuracy in articulating the treated stimuli but also for untreated items on different tasks of the language test. Moreover, although after the sham condition connectivity changes were confined to the right brain hemisphere, real stimulation yielded to stronger functional connectivity increase in the left hemisphere. In conclusion, our data provide converging evidence from behavioral and functional imaging data that bilateral tDCS determines functional connectivity changes within the lesioned hemisphere, enhancing the language recovery process in stroke patients.
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http://dx.doi.org/10.1162/jocn_a_00927DOI Listing
May 2016