Marcella Caglio

Brain volumetric abnormalities in patients with anorexia and bulimia nervosa: A Voxel-based morphometry study

Recent studies focussing on neuroimaging features of eating disorders have observed that anorexia nervosa (AN) is characterized by significant grey matter (GM) atrophy in many brain regions, especially in the cerebellum and anterior cingulate cortex. To date, no studies have found GM atrophy in bulimia nervosa (BN) or have directly compared patients with AN and BN. We used voxel-based morphometry (VBM) to characterize brain abnormalities in AN and BN patients, comparing them with each other and with a control group, and correlating brain volume with clinical features. We recruited 17 AN, 13 BN and 14 healthy controls. All subjects underwent high-resolution magnetic resonance imaging (MRI) with a T1-weighted 3D image. VBM analysis was carried out with the FSL-VBM 4.1 tool. We found no global atrophy, but regional GM reduction in AN with respect to controls and BN in the cerebellum, fusiform area, supplementary motor area, and occipital cortex, and in the caudate in BN compared to AN and controls. Both groups of patients had a volumetric increase bilaterally in somatosensory regions with respect to controls, in areas that are typically involved in the sensory-motor integration of body stimuli and in mental representation of the body image. Our VBM study documented, for the first time in BN patients, the presence of volumetric alterations and replicated previous findings in AN patients. We evidenced morphological differences between AN and BN, demonstrating in the latter atrophy of the caudate nucleus, a region involved in reward mechanisms and processes of self-regulation, perhaps involved in the genesis of the binge-eating behaviors of this disorder.

The Recognition of Facial Emotions in Spinocerebellar Ataxia Patients

Patients with cerebellar lesions present some affective and cognitive disorders, defining a peculiar pattern of cognitive impairment, so-called cerebellar cognitive affective syndrome. This pattern has been confirmed in many genotypes of spinocerebellar ataxias (SCA), a group of genetically defined pathologies characterized by the degeneration of the cerebellum and its connections. Recently, in SCA patients, some authors focused the interest on social cognition evidencing an impairment of theory of mind and basic emotion recognition by verbal material. The recognition of emotions in faces is an essential component of social cognition; therefore, we assessed this ability in SCA patients, expanding the study from the basic verbal emotions to the basic and social visual emotion recognition. We assessed facial emotion recognition using two basic and social emotion tasks in a group of SCA patients together with a complete clinical and neuropsychological evaluation. We compared results with the performance of a control group. We demonstrated a significant difference between patients and controls both in basic and social emotion recognition, although we found a specific impairment only for social emotions. The deficit was not correlated to clinical and demographic features. The cognitive and psychological profile did not explain the impairment in emotion recognition. This result supports the hypothesis that the impairment in social emotion recognition could be specifically related to a defect in the corticocerebellar network.

Apathy and verbal fluency in STN-stimulated PD patients. An observational follow-up study.

ObjectiveTo evaluate apathy and its relation to verbal fluency tasks in a consecutive series of 19 patients with Parkinson’s disease (PD) submitted to deep brain stimulation of the subthalamic nucleus (DBS of STN).Methods19 consecutive PD patients submitted to bilateral DBS of STN were studied for apathy pre-operatively and 17 months after surgery. The PD patients underwent a battery of cognitive tests assessing reasoning, memory and frontal executive functions, including phonemic and categorial fluency tasks. The Beck Depression Inventory (BDI) was used for depression. Apathy was assessed by means of the Apathy Scale (AS). In order to quantify changes among individual patients, the clinical criterion of more or less than 1 SD (standard z-score) was used to register a patient as improved or worsened, respectively.ResultsAfter surgery, apathy scores did not change and mood improved (p < 0.02), while a significant worsening was found in the phonemic fluency (p < 0.001). The percentage of patients with an apathy score above the recommended cut-off value (14) was 42% both before and after DBS of STN. Individual outcomes on the apathy scale (1 SD criterion) evidenced that 53% of the patients remained stable, 16% improved, while 31% worsened. This last percentage reduced to 21% (4/19) when considering only the PD patients with an apathy score ⊕4 after surgery. No significant correlation was found between the apathy scores variation and any of the neurological variables considered, and, in particular, no correlation was found between apathy and verbal fluency.ConclusionsThe results of the present study suggest that DBS of STN does not necessarily induce apathy even if individual patients show a moderate post-operative worsening of apathetic symptoms.

Linking coordinative and executive dysfunctions to atrophy in spinocerebellar ataxia 2 patients

Spinocerebellar ataxias type 2 (SCA2) is a rare genetic disorder characterised by the degeneration of the Cerebellum, its connections and many Brainstem areas. A voxel-based morphometry (VBM) analysis was performed on 12 genetically determined SCA2 patients and 31 controls, normalising the brains with two different atlases: one was created in-house with DARTEL (a diffeomorphic registration method) and the other was SUIT (an exclusive Cerebellum atlas). We administered two versions of a popular executive/planning functions test: the Tower of London, in the traditional and in a computerised version that does not require the use of hands, to correlate the regional atrophy with the tests’ performances and to discover the different associations of Cerebellum’s areas to cognitive dysfunctions. SCA2 showed a diffuse infratentorial atrophy with the whole Cerebellum and Brainstem affected, the overall patterns were highly overlapping between atlases with some minor differences. The DARTEL VBM also allowed detecting two sovratentorial clusters of atrophy, one in the left Inferior Parietal Lobule and the other in the Corticospinal Tracts. Additional analyses revealed a partial involvement of many White Matter tracts and of the Thalamus in the pathology. The classical Tower of London version correlated maximally with the right Lobule IV–V, when the computerised version correlated with the right Crus 1. The correlations of different versions of the test suggested a dissociation between the dysfunctions in SCA2: the Posterior Cerebellum was linked to the executive dysfunction while the Anterior Cerebellum was linked to the coordinative dysfunction.

Neuropsychological picture of 33 spinocerebellar ataxia cases

We administered a large battery of neuropsychological tests to an heterogeneous cohort of genetically defined spinocerebellar ataxia (SCA) patients in order to assess their cognitive profile and to compare cognitive impairment among different SCA genotypes, particularly between SCA with the classical pattern of olivo-ponto-cerebellar atrophy (SCA1 and SCA2) and those with a relatively “pure” olivo-cerebellar atrophy (SCA6 and SCA8). Our data revealed a neuropsychological picture characterized by fronto-parietal involvement with mnestic, linguistic, visuospatial, attentional, executive, and mood changes, in agreement with the cerebellar cognitive affective syndrome definition. We found a homogeneous neuropsychological profile among SCA subgroups with a prominent role of frontal dysfunction—particularly, attention, memory, and executive functions. We analyzed the possible interactions between neuropsychological pattern and clinical, demographical, and genetic variables. We found the presence of a cognitive impairment at the early stages of the disease, without visuospatial alterations, which appeared later. Age and education represented the most important demographic factors to predict the neuropsychological performance in SCA and in controls, but their effect in patients had definitely more impact. In our sample education could represent a protective factor and a marker of an enriched environment or a better developmental cognitive differentiation. We demonstrated that in our patients there was a distinct subgroup of high functional subjects and that triplet repeats modulated the effect of aging on cognition and progression of motor disability.

Video game play changes spatial and verbal memory: rehabilitation of a single case with traumatic brain injury

IntroductionTraumatic brain injury (TBI) occurs when mechanicalforce causes damage to brain tissue resulting in the dis-ruption of brain functioning. Cognition is frequentlydamaged after TBI; although the effects of TBI can bevariable, the domains of memory, attention, and executivefunctioning are consistently impaired. Memory deficit isone of the most (if not the most) common and disablingimpairments caused by TBI (Vakil 2005).Theuseof3D video games inbraindamagerehabilitationis a very little explored resource at the present time. 3Dvideo games are based on virtual reality technology. Theadvantage of using VR in cognitive rehabilitation is tosimulate many real life situations, thereby providing theopportunity for more ecologically valid and dynamicassessment and training (Rose et al. 2005). The utility of thismethod has been established through some spatial memorystudies (see Rose et al. 2005). It has been shown that navi-gation ofavirtualenvironmentallowsparticipantstoencodethe spatial layout of the virtual environment and activate anetwork of areas as the Hippocampus involved in memoryprocessing(Maguireetal.1998).Someauthorsassumedthathippocampal activations are more likely to be observedwhen the knowledge acquired concerns a complex anddetailed large-scale spatial layout (Woollett et al. 2008).The aim of this exploratory study was to assess themodifications occurring in cognitive functions, in particularspatial and verbal memory, and a potential fMRI increaseof signal in hippocampal and extrahippocampal brainregions in a TBI patient after a 3D video game rehabili-tation training.MethodsThe present study describes the rehabilitation of a 24-year-old, right-handed man, with 8 years of education. Hismedical history was unremarkable till when he wasinvolved in a motor vehicle crash and sustained a TBI ofmoderate severity. His Glasgow Coma Scale score was 5.He was diagnosed with trauma cranial injury. The patientwas tested 7 months after the event and was not in the post-traumatic amnesia (PTA) stage.Neuropsychological assessment indicated the presenceof a severe anterograde (recall and recognition) and retro-grade amnesia and deficits in spatial learning (supra-spanon Corsi’s test).Thetraining consistedofaseries of1.5 hsessions thriceaweek(totallengthofintervention:5 weeks).Thevideogamewas a driving simulator. During the training the participantwas requested to explore a complex virtual town from aground-levelperspective.Ineachtrainingsessionthesubjectinterchanged 20 min of navigation with 7 min of break.The patient was evaluated before and after training bymeans of a fMRI and a standardized neuropsychologicalassessment. He was then re-tested 1 and 2 months after thelast memory training session for two follow-up testingsessions.

Neuropsychiatric symptoms three years after subthalamic DBS in PD patients

ObjectiveTo evaluate neuropsychiatric symptoms in PD patients submitted to bilateral deep brain stimulation of the subthalamic nucleus (DBS-STN) by comparison with a control group of PD patients not treated with DBS.Methods25 consecutive PD patients bilaterally implanted for DBS of STN (DBS group) were compared to a control group of 25 not operated PD patients (CT group) for mood, anxiety and personality traits. The two group were matched for age, sex, duration and severity of the illness. DBS PD patients were assessed three years after surgery. Mood was evaluated through the Beck Depression Inventory (BDI). Anxiety was measured by means of the State-Trait Anxiety Inventory (STAI X1-X2) and personality traits were evaluated with the Structured Clinical Interview for the DSM-IIIR Axis II Disorders (SCID II).ResultsComparing the DBS group and the CT group, no significant differences were found for mood (BDI) or state and trait anxiety scores (STAI X1-X2). Obsessive-compulsive traits scores were found to be significantly lower in the DBS group (p < 0.03).ConclusionsThe results of this case-control study suggest that STN DBS does not lead to relevant modifications of mood, anxiety and personality provided that PD patients are well selected for the surgical treatment.

Virtual navigation for memory rehabilitation in a traumatic brain injured patient

The use of 3D video games in memory rehabilitation has been explored very little. A virtual navigation task allows participants to encode the spatial layout of the virtual environment and activate areas involved in memory processing. We describe the rehabilitation of a 24-year-old man with traumatic brain injury presenting memory deficits, and evaluate the efficacy of a navigational training program measuring neuropsychological changes and fMRI modification cerebral activations. Memory improvement appears to be present both after navigational training and in follow-up testing. Furthermore, fMRI data suggest that this training may increase activation of the hippocampal and parahippocampal brain regions. The results suggest that intensive training in virtual navigational tasks may result in an enhancement of memory function in brain-damaged adults.

Brain correlates of alexithymia in eating disorders: A voxel-based morphometry study.

Alexithymia is a personality trait that consists of difficulty in identifying and acknowledging ones own and others feelings. Recent studies reported that alexithymia is present in both anorexia (AN) and bulimia nervosa (BN). Brain morphological studies on healthy subjects showed that alexithymia correlates with several brain regions involved in emotions processing. The aim of this study was to investigate the anatomical correlates of alexithymia in AN and BN.

Neurologic and cognitive outcomes after aortic arch operation with hypothermic circulatory arrest.

BACKGROUNDnNeurologic injury is still a frequent cause of mortality, morbidity, and long-lasting disability in patients undergoing an aortic arch operation with hypothermic circulatory arrest. The aim of this analysis was to evaluate short- and long-term outcomes in neurologic and cognitive functions in this group of high-risk patients.nnnMETHODSnA total of 333 patients undergoing an aortic arch operation between February 2004 and June 2010 were retrospectively reviewed. Cerebral protection was obtained with deep hypothermic circulatory arrest in 220 patients (66%) or with moderate hypothermic circulatory arrest in 113 cases (34%). Straight deep hypothermic circulatory arrest was adopted in 35 cases (11%), while the association with antegrade cerebral perfusion was adopted in 271 cases (81%) and with retrograde cerebral perfusion in 27 cases (8%). Seventy-eight patients were enrolled in a case control prospective study (mean follow-up timexa0=xa042xa0months) and underwent neuropsychologic evaluations; data were compared with those of a matched-control group of hypertensive patients without history of cardiac operations.nnnRESULTSnForty-one out of 333 patients experienced permanent neurologic dysfunction (12%) and 83 experienced temporary neurologic dysfunctions (25%). Acute aortic dissection and deep hypothermic circulatory arrest were significant predictors of mortality and permanent neurologic dysfunction. Acute aortic dissection and hypothermic circulatory arrest duration >30xa0minutes were significant predictors of temporary neurologic dysfunction, while antegrade cerebral perfusion was protective on mortality. Neuropsychologic evaluations showed no significant differences between the groups. The operative group showed worse verbal and working memory (Pxa0=xa0.003), worse semantic fluency (Pxa0=xa0.036), higher degree of alexithymia (Pxa0=xa0.004), and a lower quality of life (Pxa0=xa0.007).nnnCONCLUSIONnAlthough moderate hypothermic circulatory arrest with antegrade cerebral perfusion demonstrated a lower mortality compared with deep hypothermic arrest, neurocognitive testing demonstrated no difference between the groups. Additionally, patients undergoing an aortic arch operation demonstrated long-term cognitive deficits and psychological dysfunction when compared to a matched cohort of nonoperative patients.