Alessio Toraldo

Cognitive development in Dravet syndrome: a retrospective, multicenter study of 26 patients.

Purpose:  To clarify the role of epilepsy and genetic background in determining the cognitive outcome of patients with Dravet syndrome.

Dissociation between the mental rotation of visual images and motor images in unilateral brain-damaged patients.

Deficits in the mental rotation of body parts and of external objects can be doubly dissociated (Rumiati, Tomasino, Vorano, Umiltà, & De Luce, 2001; Sirigu & Duhamel, 2001; Tomasino, Rumiati, & Umità, in press). The aim of this study was to replicate this finding and to then investigate the relevance of the specific hemispheres in these deficits. Nine patients with unilateral lesions (five in the Left Hemisphere and four in the Right) and 20 control subjects, performed a single task requiring mental rotation of hands, and two tasks requiring mental rotation of external objects. RH patients were impaired in the rotation of external objects, but showed intact performance on the rotation of hands; the opposite pattern was found for LH patients. These results support the view that the LH contributes to the mental rotation of hands, recruiting processes specific to motor preparation, while the RH is specialized for mental rotation of external objects.

Critical Dimensions Affecting Imitation Performance of Patients with Ideomotor Apraxia

The conceptualisation of apraxia has often been linked to the clinicalassessment of the disorder (Rothi et al., 1997). Thus Ideomotor Apraxia(hereafter IMA) has been described as a failure to imitate actions. One of thetasks more widely employed by clinicians is that devised by De Renzi et al.,(1980). The 24 gestures of this test vary according to a 2x2x2 design, the threefactors being (i) gestures composed of a single posture (‘positions’) vs. asequence of postures (‘sequences’); (ii) involving hand and/or arm vs. fingers;(iii) symbolic vs. non-symbolic (see De Renzi and Faglioni, 1999, for detailsabout the items). Specific predictions involving all these gestures were madebased on a model that comprises a Long-Term Memory (LTM), a ‘MotorProgramming’ (MP) component, and a Working Memory (WM) (Baddeley,1986) including a Short-Term Memory component specific for gestures (STM;Smyth and Pendleton, 1988; Rumiati and Tessari, in press) and the SupervisoryAttentional System (SAS, Norman and Shallice, 1986) (Fig. 1).The gesture to be imitated is temporarily held in the STM (while the SASselects, whenever necessary, alternative strategies for the gesture encoding), andthen transferred to the MP system. When a gesture is symbolic, the WM loadcan be reduced by accessing its LTM representation. IMA per sewouldcorrespond to a breakdown at MP level, while damage to the WM componentwould produce an inability to maintain the gesture (STM) or to selectappropriate strategies (SAS) beforethe MP stage.The WM and LTM components have an overall probability wof maintainingand transferring to MP an accurate copy of the input gesture. When a non-

Exploring motor and visual imagery in Amyotrophic Lateral Sclerosis

Amyotrophic Lateral Sclerosis (ALS) is a motor neuron disease characterized by the progressive atrophy of both the first and the second motor neurons. Although the cognitive profile of ALS patients has already been defined by the occurrence of language dysfunctions and frontal deficit symptoms, it is less clear whether the degeneration of upper and lower motor neurons affects motor imagery abilities. Here, we directly investigated motor imagery in ALS patients by means of an established task that allows to examine the presence of the effects of the biomechanical constraints. Twenty-three ALS patients and 23 neurologically unimpaired participants have been administered with the (1) hand laterality task (HLT) in which participants were asked to judge the laterality of a rotated hand and the (2) mirror letter discrimination task (MLD) in which participants were asked to judge whether a rotated alphanumeric character was in its canonical or mirror-reversed form (i.e. control task). Results show that patients present the same pattern of performance as unimpaired participants at the MLD, while at the HLT, they present only partially with the effects of biomechanical constraints. Taken together, our findings provide evidences that motor imagery abilities, related to the mental simulation of an action, are affected by this progressive disease.

Canceling out both the real and the spectral lines

Neglect patients typically show motor perseveration while canceling targets on the ipsilesional side. This behavior can be influenced by the presence vs. absence of targets on the (neglected) contralesional side (). As alternative explanations, the authors proposed (i) directional hypokinesia--the patient cannot perform reaching movements towards detected left-sided targets, and thus carries on canceling on the right side, and (ii) allochiria--the patient misperceives left-sided targets as located on the right side, and cancels them there. We report here data from a patient (EZ) that might confirm the second hypothesis. EZ was presented with 19 displays in which the number and position of cancellation targets on both sides were varied systematically. EZ showed motor perseveration while canceling, but this tendency did not vary across conditions. Interestingly though, EZ also drew cancellation marks in the empty space between the ipsilesional targets, and this phenomenon was significantly more intense when there were more targets on the neglected side. As EZs comments suggested, such a behavior might reflect the attempt to cancel out delusional targets. Our speculation is that those objects were generated by allochiria.

Cognitive behavioral group intervention for alzheimer caregivers

Long-term caregiving of patients with Alzheimer disease (AD) frequently induces a relevant distress enhanced by inadequate coping strategies. This study aimed to explore the impact of cognitive and behavioral therapy (CBT) group intervention on AD patients’ caregivers. In particular, reduction in caregivers’ global care needs and in anxiety and depression has been investigated. About 100 caregivers were divided into the following groups: CBT group intervention, self-help manual, and control have been enrolled in the study. CBT group intervention seems to be more effective than the other 2 conditions in reducing caregivers’ anxiety. Furthermore, only caregivers of the CBT group showed significant needs related to reduction in care. The proposed treatment could be the core of a more structured and systematic intervention for AD patients’ caregivers in Italy.

Aftereffect induced by prisms of different power in the rehabilitation of neglect: A multiple single case report

OBJECTIVES Prism Adaptation (PA) is a technique used in the rehabilitation of unilateral spatial neglect. Several researchers have reported positive results on a number of tasks, but negative outcomes have also been reported. These conflicting results could be due to the use of prisms of different power. The aim of this study was to investigate the amplitude and duration of the aftereffect induced by prisms of different power by different measures in a series of single cases of neglect. METHODS Five neglect patients and ten control subjects participated in the study. Prism adaptation was evaluated with Subjective Straight Ahead (SSA), Open-Loop Pointing (OLP) and Line Bisection (LB) tasks, immediately before prism adaptation, immediately after, and 10/60 minutes after prism adaptation. The procedure was repeated with prisms of 5, 10 and 20 prismatic diopters (Δ). RESULTS The OLP task provided the most sensitive measures for the size of the aftereffect. The 20Δ prism proved to be most effective in inducing an immediate aftereffect, while the aftereffect of the 5Δ prism seemed to last longer. CONCLUSION We showed that the prism power and the task used for assessing PA effect are relevant variables to be consider in clinical practice of neglect rehabilitation.

Prolonged grief in caregivers of community-dwelling dementia patients

Objectives: To estimate the frequency of prolonged grief disorder (PGD) in 90 primary caregivers of patients with dementia who live in the community dwelling in Milan and to identify the relationship between grief intensity (GI) and other caregiver variables; another aim was to clarify the role of the objective cognitive and functional impairment of the patients and the level of deterioration perceived by caregivers. Design: Cross-sectional study. Results: In all, 16.7% of caregivers had PGD. Caregiver variables increasing GI and the risk of developing PGD were burden, anxiety, and some sociodemographic features. The objective level of patient’s deterioration was irrelevant for PGD probability/GI, while the deterioration level perceived by the caregiver increased PGD probability and GI. Conclusions: Caregivers of patients with dementia may experience grief symptoms that are associated with low educational level, high level of burden and anxiety, and high perceived deterioration of their demented relatives’ cognitive and functional abilities.

Perceptual and response-related components of unilateral neglect may evolve independently of one another: Evidence from five single-case studies

Abstract The Milner Landmark Task allows the disentanglement of perceptual and response-related components of unilateral neglect. If these two components reflect separate functional systems, then cases should be observed in which the two components evolve differently across time. To test this hypothesis we surveyed a continuous series of 21 right hemisphere stroke patients. Five patients from the sample were affected by unilateral neglect at the outset and could be submitted to repeated administrations of the Landmark task in the first weeks post stroke. Two versions of the task were used, Landmark-Manual and Landmark-Verbal, differing in the type of response required. Two patients showed independent changes in the perceptual and the response-related component of neglect, hence confirming the view of separate functional systems underlying them. Dissociations between the task versions were found, witnessing a role of the type of response. Unexpectedly, one patient showed an initial leftward deviation of the subjective midpoint of the stimulus line, which later reversed to a classical rightward deviation. We interpreted such a pattern in terms of co-existing “productive” and “negative” components of perceptual neglect.

Prismatic Adaptation in the Rehabilitation of Neglect Patients: Does the Specific Procedure Matter?

In rehabilitation studies, adaptation to lateral displacing prisms (rightward optical deviation) has been shown to reduce many manifestations of unilateral spatial neglect (USN) (Rossetti et al., 1998; Striemer and Danckert, 2010) and, when compared to other bottom-up techniques, has been proved to be effective for a longer time (Luaute et al., 2006a; Pisella et al., 2006; Newport and Schenk, 2012).