Giuseppe Bomboi

Clinical findings, functional abilities and caregiver distress in the early stage of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD)

Few studies have compared neuropsychiatric disorders and functional abilities in the early stage of DLB and AD and their influence on caregiver distress. The aim of this study is to assess neuropsychiatric disorders, functional abilities and caregiver distress in DLB and in AD subjects. Sixteen subjects affected by probable DLB and 12 subjects affected by probable AD were enrolled. All subjects underwent a wide neuropsychological examination. Caregivers distress was also assessed. Subjects affected by DLB performed better in long-term memory tests, whereas AD subjects performed better in attentive and executive function tests. The Neuropsychiatric Inventory (NPI) total score was significantly higher in DLB subjects than in AD subjects. Furthermore, DLB subjects scored worse than AD subjects in both Activities of Daily Living scale (ADL) and Instrumental Activities of Daily Living scale (IADL) scales. Overall caregiver distress was higher in DLB than in AD subjects. High distress was observed in DLB caregivers alone and was caused by delusion, hallucinations, anxiety and apathy. DLB subjects have a different neuropsychological profile, more psychiatric symptoms and more serious functional deficits than AD subjects in the early cognitive decline, furthermore DLB caregivers are more stressed than AD caregivers.

White matter microstructural alterations in migraine: A diffusion-weighted MRI study

Summary White matter disintegration, as measured by diffusion‐weighted MRI, is reported in migraineurs, and is speculated to be either a marker of possible white matter disintegration or maladaptive plasticity. Abstract Migraine is a common and disabling neurological disease. The pathomechanism that underlies the disorder is not entirely understood, and reliable biomarkers are missing. In the current analysis we looked for microstructural alterations of the brain white matter in migraine patients by means of diffusion‐weighted magnetic resonance imaging. The measurements were carried out with a novel approach based on fine‐tuned nonlinear registration and nonparametric permutation test in an alignment‐invariant tract representation (Tract‐Based Spatial Statistics). We found reduced fractional anisotropy in the right frontal white matter cluster of migraine patients. In the same region we also found increased mean diffusivity and increased radial diffusivity. The probabilistic tractography showed connection of this cluster to other parts of the pain network (orbitofrontal cortex, insula, thalamus, dorsal midbrain). We speculate that these findings reflect maladaptive plastic changes or white matter disintegration.

Alzheimer’s disease and endothelial dysfunction

Recent studies suggest strong interactions between cerebrovascular and Alzheimer’s disease (AD) pathology. These conditions share common risk factors and individuals having both frequently show greater cognitive impairment than those affected by only one disease. Many studies point to early vascular dysregulations in AD. The exchange between vascular and neural cells occurs through mechanisms not completely understood, involving interactions among endothelial, glial, neuronal and smooth muscle cells within the neurovascular unit. Studies suggest that the dysregulation of the unit is likely associated with hypertension and other systemic diseases. Associations between hypertension and cognitive decline are not established, but other variables associated with hypertension could create a causal link. Many studies have lacked a consistent, quantitative neuropsychological approach for assessing cognitive functions. This approach is reductive, as the need for a formal neuropsychological assessment has gained broad recognition, and the definition of dementia has gone through revision processes, which are in progress.

MRI evidence of bilateral hippocampal sclerosis in amnestic mild cognitive impairment.

We present the case of a man affected by amnestic mild cognitive impairment (aMCI) who showed bilateral hippocampal sclerosis at magnetic resonance imaging (MRI). We argue the concept that aMCI is heterogeneous syndrome and suggested the utility of coronal T2‐weighted MRI images in the routine dementia workup.