Katia Mattarozzi

Distinguishing Between Clinical and Minimal Hepatic Encephalopathy on the Basis of Specific Cognitive Impairment

It is well-known that liver cirrhosis is frequently accompanied by a wide range of neuropsychiatric abnormalities, including general and specific cognitive impairment. The aim of this study was to investigate which cognitive functions are selectively compromised in Hepatic Encephalopathy (HE) and to clarify the relationship between clinically overt or nonovert HE and the different forms and degrees of decay in cognitive deficits. Twenty-two patients without overt HE and 12 patients who showed overt HE at the first level of severity, along with matched control subjects, were compared in several cognitive domains. The results showed significant differences in some measures of attention between patients with minimal HE (mHE) and patients with overt HE. There were also notable differences in verbal short-term memory between patients with mHE and healthy subjects. Thus, we can hypothesize that there is a linear diminution in short-term memory and attentional performance starting from healthy patients, moving toward patients with mHE, and finally progressing toward patients with the first grade of overt HE. There are two types of diminution that we noted: between patients with mHE and the overt form, the decline in the attentional domain was more evident, while between healthy subjects and mHE patients, short-term memory showed a more evident decline.

Effect of the disclosure of MS diagnosis on anxiety, mood and quality of life of patients: a prospective study

Background:  In the light of the new diagnostic criteria for multiple sclerosis (MS) and currently available early treatment, this study aimed to explore whether, and to what extent, disclosure of the diagnosis of MS or clinically isolated syndrome (CIS) affects patients’ anxiety, mood and quality of life (QoL).

Semantic priming effect during REM-sleep inertia in patients with narcolepsy.

Patients with narcolepsy-cataplexy (NC) present excessive daytime sleepiness (EDS), cataplexy and an altered architecture of nocturnal sleep, with frequent episodes of REM-sleep at sleep onset (SOREM-sleep). This altered organization of nocturnal sleep may be accompanied by some differences in the functioning of the cognitive processes involved in the access, organization and consolidation of information during sleep. This study attempts to ascertain whether the activation of semantic memory during REM-sleep, as measured using a technique of semantic priming (namely, the facilitation of the activation of strongly-related rather than weakly-related and, overall, unrelated pairs of prime-target words) is different in NC patients compared to normal subjects. A lexical decision task (LDT) was carried out twice in wakefulness (at 10a.m. and after a 24h interval) and twice in the period of sleep inertia following awakening from SOREM and 4th-cycle REM-sleep on 12 NC patients and from 1st- and 4th-cycle REM-sleep on 12 matched controls. Reaction time (RT) to target words, taken as a measure of the semantic priming effect, proved to be longer (a) in NC patients than in control subjects; (b) in the period of REM-sleep inertia than in wakefulness; (c) in the first rather than the second session; and (d) for unrelated compared to weakly-related and, overall, strongly-related prime-target pairs. RT in post-REM-sleep sessions was less impaired, compared to waking sessions, and less dependent on the associative strength of prime-target pairs in NC patients than in normal subjects. Finally, RT of NC patients, although longer than that of normal subjects in waking sessions, significantly improved in the second session, as a consequence of either the amount of exercise or the consolidation advantage provided by REM-sleep for the procedural components of the task. The whole picture suggests a greater effectiveness of the activation of semantic memory during (SO)REM-sleep in NC patients rather than in normal subjects, and overall for the organization of new and unexpected relationships (such as those between unrelated pairs) between items of information.

Memory for faces: the effect of facial appearance and the context in which the face is encountered.

AbstractWe investigated the effects of appearance of emotionally neutral faces and the context in which the faces are encountered on incidental face memory. To approximate real-life situations as closely as possible, faces were embedded in a newspaper article, with a headline that specified an action performed by the person pictured. We found that facial appearance affected memory so that faces perceived as trustworthy or untrustworthy were remembered better than neutral ones. Furthermore, the memory of untrustworthy faces was slightly better than that of trustworthy faces. The emotional context of encoding affected the details of face memory. Faces encountered in a neutral context were more likely to be recognized as only familiar. In contrast, emotionally relevant contexts of encoding, whether pleasant or unpleasant, increased the likelihood of remembering semantic and even episodic details associated with faces. These findings suggest that facial appearance (i.e., perceived trustworthiness) affects face memory. Moreover, the findings support prior evidence that the engagement of emotion processing during memory encoding increases the likelihood that events are not only recognized but also remembered.

Effects of Gender and Personality on First Impression

The present study explores whether and to what extent individual differences (i.e., gender and personality traits of perceiver) predict inferences of trustworthiness from emotionally neutral unfamiliar faces and the related confidence in judgment. Four hundred and ten undergraduate students participated in the study. Personality was assessed using the Big Five model (i.e., Extraversion, Neuroticism, Conscientiousness, Agreeableness and Openness to experience) and measures of trait anxiety and aggression. The results suggest that trustworthiness judgments are affected by the gender of the perceiver, although this effect depends on the valence of the face. Women tend to judge trustworthy-looking faces as significantly more trustworthy than men do, and this is particularly pronounced for judgments of female faces. There were no gender differences for judgments of untrustworthy-looking or neutral faces. Gender also seems to affect the confidence in judgment. Specifically, women were generally less confident than men in judging trustworthiness of unfamiliar faces. Personality also affected judgment. Both low agreeable individuals and high trait aggressive individuals tend to perceive unfamiliar faces as less trustworthy. The present findings suggest that both gender and personality traits are relevant for understanding how people evaluate the trustworthiness of others. Whom we decide to trust is a function not only of their facial features but also of gender and individual differences in personality traits.

Continuity of the processing of declarative knowledge during human sleep: evidence from interrelated contents of mental sleep experiences.

The positive influence of sleep on memory may partly depend on the processing which transforms items of declarative knowledge into contents of mental sleep experience (MSE). This view implies that the consolidation level should be more enhanced for those items which have been repeatedly processed and transformed into identical or very similar (so-called interrelated) contents of distinct MSEs in the same night. We examined here the occurrence of interrelated contents in the MSEs reported after an awakening provoked in stage 2 at sleep onset and the spontaneous awakening in the morning. Interrelated contents resulted much more frequently than the chance occurrence of contents with the same semantic features, regardless of the sleep stage in which morning awakening occurred. The accessibility of given items for transformation into MSE contents over the night makes it plausible that they are reprocessed, and thus further consolidated, during various stages and cycles of sleep.

Sleep-dependent consolidation of motor skills in patients with narcolepsy-cataplexy

BACKGROUND AND OBJECTIVES This study investigated whether the altered organization of post-training sleep in patients with narcolepsy-cataplexy (NC) is associated with a lower off-line improvement in the consolidation of motor skills compared with normal subjects. STUDY DESIGN Fourteen drug-naive NC patients, fulfilling the international clinical and polysomnographic diagnostic criteria, and 14 individually-matched controls underwent training at a sequential finger tapping task (FTT) and were re-tested on the next morning (after a night with polysomnographic recording) and after another six nights (spent at home). SETTING Training and retrieval sessions were performed in a controlled laboratory setting. RESULTS FTT performance was worse in NC patients than controls at training and at both retrieval sessions and showed a fairly different time course (slower than in controls) of consolidation. Several sleep indices (lower values of stage-2 NREM sleep and SWS) were compatible with a lower effectiveness of sleep for consolidation of motor skills in NC patients, although no statistically significant relationship was found between such indices and improvement rate. CONCLUSION The consolidation process of motor skills results less effective in NC patients since training and slower than in normal subjects over the week following training. The wider variations in performance scores and sleep parameters of post.-training night in NC patients relative to controls suggest that a) the lower initial consolidation may be due to a less effective encoding consequent to altered prior sleep, and b) the consolidation process over the 24 h following training is negatively influenced not only by the altered characteristics of post-training sleep, but also by the daytime sleepiness following training.

Assessing subjective quality of life domains after multiple sclerosis diagnosis disclosure.

An investigation of the domains Italian patients with multiple sclerosis (MS) named as constituting their quality of life over time.

Use of Rasch analysis to refine a patient-reported questionnaire on satisfaction with communication of the multiple sclerosis diagnosis

Background: The Comunicazione medico-paziente nella Sclerosi Multipla – Revised (COSM-R) is a patient self-assessed questionnaire probing the moment of multiple sclerosis (MS) diagnosis disclosure (section 1, five items) and following period (section 2, 15 items). Objectives: This study examined COSM-R dimensionality and measurement properties through Rasch analysis (partial-credit model) and proposed a revised questionnaire. Methods: Cross-sectional COSM-R data were obtained from 1068 people with MS (PwMS, 1065 questionnaires) participating in four studies (102 centres). Mean age was 40 years (range 17–73); 70% were women; 53% were from Northern, 25% from Central, and 21% from Southern Italy. Results: Unidimensionality was not confirmed for COSM-R section 1, but was for section 2 after removal of three items. The revised instrument (COSM-S, Shortened) consisted of the original five-item checklist (section 1), modified by removing the table grouping of three items, and 12 of the original 15 section 2 items, which could now be summed and transformed into an interval scale. Scores were higher for items assessing emotional satisfaction than for those assessing informational satisfaction. Conclusions: The proposed COSM-S is a composite measure of satisfaction with MS diagnosis communication with improved metric properties over the original COSM-R, and whose section 2 satisfies Rasch model expectations.

Effect of organizational features on patient satisfaction with care in Italian multiple sclerosis centres

Receiving clear, complete and up‐to‐date information and having a satisfying relationship with the health professional (HP) are of primary importance for MS patients. Healthcare organization plays a key role in promoting an effective relationship and communication between patients and HPs. The present study aims to explore which care organization and service characteristics provided by Italian MS centres best predict patients’ satisfaction with healthcare.