Francesca Burgio

Acalculia, Aphasia and Spatial Disorders in Left and Right Brain-Damaged Patients

The paper reports the performance of 50 left- and 26 vascular right-brain-damaged (LBD, RBD) patients in the EC301 Calculation Battery, which explores different aspects of number and calculation processing. All patients underwent a comprehensive neuropsychological testing that also included evaluation for the presence and type of aphasia in LBD patients, and of spatial disorders in RBD patients. LBD were subdivided in three groups: non-aphasic (NA), Broca and Wernicke aphasics. Results indicate that language and calculation disorders can dissociate. The relationship between spatial and calculation disorders in RBD patients is less clear. No significant difference was found between Broca and Wernicke aphasics, nor between NA and RBD patients. In the transcoding tasks (reading or writing to dictation numbers and number words, for instance) syntactic errors were the most frequent type of errors in all groups. They were also present when neither the input nor the required response was in the Arabic code, and a word-by-word strategy could have been used to read the number word or write a spoken number in the orthographic code.

A new clinical tool for assessing numerical abilities in neurological diseases: numerical activities of daily living.

The aim of this study was to build an instrument, the numerical activities of daily living (NADL), designed to identify the specific impairments in numerical functions that may cause problems in everyday life. These impairments go beyond what can be inferred from the available scales evaluating activities of daily living in general, and are not adequately captured by measures of the general deterioration of cognitive functions as assessed by standard clinical instruments like the MMSE and MoCA. We assessed a control group (n = 148) and a patient group affected by a wide variety of neurological conditions (n = 175), with NADL along with IADL, MMSE, and MoCA. The NADL battery was found to have satisfactory construct validity and reliability, across a wide age range. This enabled us to calculate appropriate criteria for impairment that took into account age and education. It was found that neurological patients tended to overestimate their abilities as compared to the judgment made by their caregivers, assessed with objective tests of numerical abilities.

Zero in the brain: A voxel-based lesion-symptom mapping study in right hemisphere damaged patients.

Transcoding numerals containing zero is more problematic than transcoding numbers formed by non-zero digits. However, it is currently unknown whether this is due to zeros requiring brain areas other than those traditionally associated with number representation. Here we hypothesize that transcoding zeros entails visuo-spatial and integrative processes typically associated with the right hemisphere. The investigation involved 22 right-brain-damaged patients and 20 healthy controls who completed tests of reading and writing Arabic numbers. As expected, the most significant deficit among patients involved a failure to cope with zeros. Moreover, a voxel-based lesion-symptom mapping (VLSM) analysis showed that the most common zero-errors were maximally associated to the right insula which was previously related to sensorimotor integration, attention, and response selection, yet for the first time linked to transcoding processes. Error categories involving other digits corresponded to the so-called Neglect errors, which however, constituted only about 10% of the total reading and 3% of the writing mistakes made by the patients. We argue that damage to the right hemisphere impairs the mechanism of parsing, and the ability to set-up empty-slot structures required for processing zeros in complex numbers; moreover, we suggest that the brain areas located in proximity to the right insula play a role in the integration of the information resulting from the temporary application of transcoding procedures.

Re-assessing acalculia: Distinguishing spatial and purely arithmetical deficits in right-hemisphere damaged patients

Arithmetical deficits in right-hemisphere damaged patients have been traditionally considered secondary to visuo-spatial impairments, although the exact relationship between the two deficits has rarely been assessed. The present study implemented a voxelwise lesion analysis among 30 right-hemisphere damaged patients and a controlled, matched-sample, cross-sectional analysis with 35 cognitively normal controls regressing three composite cognitive measures on standardized numerical measures. The results showed that patients and controls significantly differ in Number comprehension, Transcoding, and Written operations, particularly subtractions and multiplications. The percentage of patients performing below the cutoffs ranged between 27% and 47% across these tasks. Spatial errors were associated with extensive lesions in fronto-temporo-parietal regions -which frequently lead to neglect- whereas pure arithmetical errors appeared related to more confined lesions in the right angular gyrus and its proximity. Stepwise regression models consistently revealed that spatial errors were primarily predicted by composite measures of visuo-spatial attention/neglect and representational abilities. Conversely, specific errors of arithmetic nature linked to representational abilities only. Crucially, the proportion of arithmetical errors (ranging from 65% to 100% across tasks) was higher than that of spatial ones. These findings thus suggest that unilateral right hemisphere lesions can directly affect core numerical/arithmetical processes, and that right-hemisphere acalculia is not only ascribable to visuo-spatial deficits as traditionally thought.

Morphosyntactic production in Greek- and Italian-speaking individuals with probable Alzheimer’s disease: evidence from subject–verb agreement, tense/time reference, and mood

ABSTRACT Background: In probable Alzheimer’s disease (AD), different memory systems, executive functioning, visuospatial recognition, and language are impaired. Regarding the latter, only a few studies have investigated morphosyntactic production thus far. Aims: This study, which is a follow-up on Fyndanis, V., Manouilidou, C., Koufou, E., Karampekios, S., and Tsapakis, E. M. (2013). Agrammatic patterns in Alzheimers disease: Evidence from tense, agreement, and aspect. Aphasiology, 27, 178–200. doi:10.1080/02687038.2012.705814, investigates whether verb-related morphosyntactic production is (selectively) impaired in AD focusing on two highly inflected languages, Greek and Italian. The morphosyntactic phenomena explored are subject–verb Agreement, Tense/Time Reference, and Mood. Focusing on these phenomena allows us to investigate if recent hypotheses, originally developed in aphasia research, can also capture results related to AD. We tested the hypotheses discussed in Fyndanis, V., Manouilidou, C., Koufou, E., Karampekios, S., and Tsapakis, E. M. (2013). Agrammatic patterns in Alzheimers disease: Evidence from tense, agreement, and aspect. Aphasiology, 27, 178–200. doi:10.1080/02687038.2012.705814, that is, the Interpretable Features’ Impairment Hypothesis (IFIH) (e.g., Fyndanis, V., Varlokosta, S., & Tsapkini, K. 2012. Agrammatic production: Interpretable features and selective impairment in verb inflection. Lingua, 122, 1134–1147. doi:10.1016/j.lingua.2012.05.004) and the PAst DIscourse LInking Hypothesis (PADILIH; Bastiaanse, R., Bamyaci, E., Hsu, C., Lee, J., Yarbay Duman, T., & Thompson, C. K. 2011. Time reference in agrammatic aphasia: A cross-linguistic study. Journal of Neurolinguistics, 24, 652–673. doi:10.1016/j.jneuroling.2011.07.001). Methods & Procedures: Two sentence completion tasks testing the production of subject–verb Agreement, Tense/Time Reference, and Mood were administered to 16 Greek-speaking and 10 Italian-speaking individuals with mild-to-moderate AD, as well as to 16 Greek-speaking and 11 Italian-speaking neurologically intact individuals who were matched with the participants with AD on age and education. Mixed-effects models were fitted to the data. Outcomes & Results: At the group level, both the Greek and Italian participants with AD performed worse than the controls. Both AD groups revealed selective patterns of morphosyntactic production (Greek: Agreement/Mood > Time Reference; Italian: Agreement > Time Reference > Mood). Past Reference and Future Reference did not dissociate in either of the two AD groups. Nevertheless, in all four participants with AD who showed dissociations, Past Reference was more impaired than Future Reference. Conclusions: The results indicate that the production of verb-related morphosyntactic categories can be impaired in mild-to-moderate AD. The different patterns observed in the two languages are partly attributable to the different way these languages encode Mood. The group results (of both the Greek- and Italian-speaking participants with AD) do not lend support to the PADILIH, whereas only the results of the Italian AD group are fully consistent with the IFIH. However, the individual data are consistent with the PADILIH, and the IFIH is informed by the present data and modified accordingly so that it can capture cross-linguistic patterns of morphosyntactic impairment.

Numerical Activities of Daily Living – Financial (NADL-F): A tool for the assessment of financial capacities‡

ABSTRACT Financial capacity is the ability to manage one’s own finances according to self-interests. Failure in financial decisions and lack of independence when dealing with money can affect people’s quality of life and are associated with neuropsychological deficits or clinical conditions such as mild cognitive impairment or Alzheimer’s disease. Despite the importance of evaluating financial capacity in the assessment of patients with neuropsychological and psychiatric disorders, only a few tools have been developed. In the present article, the authors introduce the Numerical Activities of Daily Living – Financial (NADL-F) test, a new test to assess financial capacity in clinical populations. The NADL-F is relatively short, yet it encompasses the most common activities involving financial capacities. The NADL-F proved to have satisfactory psychometric properties and overall good validity for measuring financial abilities. Associations with performance on basic neuropsychological tests were investigated, in particular focusing on mathematical abilities as cognitive correlates of financial capacity. Results indicate that the NADL-F could be a useful tool to guide treatments for the enhancement of financial capacities. By sharing all materials and procedures, the authors hope to promote the development of further versions of the NADL-F in different languages, taking into account the necessary adjustments related to different socio-cultural contexts.

Normative data for the Italian version of the Montreal Cognitive Assessment (MoCA): the impact of sociocultural variables on cut-offs

Objective: Cognitive dysfunction is common in patients with primary brain tumors and it is now recognized as an independent prognostic factor in survival. In addition, cognitive functioning has a major impact on quality of life and the ability to perform activities of daily living. Previous studies have mainly focused on glioma patients. This prospective follow-up study focuses on cognitive functioning in meningioma patients before and after surgery. Participants and Methods: Sixty-one meningioma patients, who underwent an intracranial neurosurgical procedure in the St. Elisabeth Hospital, were assessed one day before surgery and 3 months after surgery. To identify the impaired domains of cognitive function, all patients were assessed with a computerized neuropsychological test, CNS Vital Signs. The standard scores of the patients on seven cognitive domains were compared with the normative healthy American control group from CNS VS by means of one-tailed one-sample t-tests. Results: Meningioma patients showed significantly lower scores on all cognitive domains preoperatively, in comparison with healthy controls (p < 0.05). After surgery, the performance of the patients was significantly lower on the domains of memory, psychomotor speed, reaction time and complex attention. Their scores on the three other domains (cognitive flexibility, processing speed and executive functioning) did not deviate from the controls. Conclusions: Based on these results, we can conclude that meningioma patients are faced with substantial cognitive dysfunction in several cognitive domains both pre- and postoperatively. This study emphasizes the importance of the use of neuropsychological tests to identify cognitive deficits in meningioma patients, so that appropriate treatment can be provided.

OBESITY AS A RISK FACTOR IN THE EARLY STAGE OF NEURODEGENERATION: RELATIONSHIP BETWEEN BODY MASS INDEX AND BRAIN STRUCTURE

nosed PD patients (n1⁄4198) and an age-matched control group (n1⁄493). Results: We performed 10-fold cross-validation experiments and measured grading values for the substantia nigra (SN) and subthalamic nucleus (STN). The classifier performance was tested by estimating the Area Under the receiver operating characteristic Curve (AUC). Our results showed statistically significant differences in grading values for left SN (p1⁄40.013) and left STN (p1⁄40.0002) between patients and controls. When used to classify individual subjects in the cross-validation experiment the performance of the classifier yields an AUC1⁄40.662 for the left SN, and AUC1⁄40.733 for the left STN. Conclusions: We have shown that our method could be applied for detecting PD with AUC similar to Alzheimer Disease vs NC detection shown previously (AUC1⁄40.73 for hippocampal grading in AD, Coupe et al, 2015).

Long-term follow-up of ideomotor apraxia: A response to Cauraugh

Cauraugh (2002), taking as a starting point a paper by Basso, Burgio, Paulin, and Prandoni (2000), writes a stimulating lesson on statistical deontology, which we appreciate both for its purpose and its content. However, we feel it right and proper to add some considerations about the statistical strategy and the neuropsychological conclusions. In the original paper, Basso et al. (2000) reported results from 44 patients with ideomotor apraxia (IMA) who underwent three successive examinations and from two subgroups of patients with either anterior (n = 6) or posterior (n = 8) lesions. They reached three conclusions: (1) that in the whole group recovery was significant in the first time interval but did not reach significance in the second time interval; (2) that initial severity significantly differed between anterior (more severely apraxic) and posterior (less severely apraxic) lesions; and (3) that recovery in the two groups did not differ significantly. Cauraugh is concerned about the repeated use of t tests instead of ANOVA. In addition, he argues that Basso et al. did not address the study of interaction effects and of circularity assumptions. He therefore conducted two ANOVAs “to further clarify recovery from ideomotor apraxia”.