Marta Zuffi

A neuropsychological instrument adding to the description of patients with suspected cortical dementia: the Milan overall dementia assessment.

A new, short, neuropsychologically oriented test for dementia assessment--the Milan Overall Dementia Assessment (MODA)--is described. Age and education adjusted norms based on 217 healthy controls are given. A validation study on 312 outpatients suspected of dementia (121 with probable Alzheimers disease) showed that the MODA differentiated patients with cognitive impairment from normal subjects more effectively than did the DSM III-R. The correlation between the MODA and the mini mental state examination was 0.63 in controls and 0.84 in patients with Alzheimers dementia. The MODA test-retest reliability was 0.83. The test proved to be well suited to longitudinal studies.

The Frontal Assessment Battery Does Not Differentiate Frontotemporal Dementia from Alzheimer’s Disease

Background: An early differentiation of Alzheimer’s disease (AD) from frontotemporal dementia (FTD) is important, since these conditions are essentially different regarding prognosis and therapeutical approach. Until now, no single test is available which allows a reliable differentiation. The Frontal Assessment Battery (FAB) has been found to have good reliability in identifying an executive deficit in frontal syndromes and in extrapyramidal disorders. The ability of the FAB to distinguish AD from FTD in mildly demented patients is less clearly assessed. Methods: We compared FAB scores in a consecutive series of 33 FTD (frontal variant) and 85 AD patients. Results: FAB global scores in the two groups were very similar, also when considering only mildly demented subgroups [Mini Mental State Examination (MMSE) score ≧20; 20 FTD and 38 AD patients]. Considering FAB subscores, only the ‘go-no go’ subtest showed a significant difference, reflecting a poorer inhibitory motor control in AD patients. FAB scores in the two groups of patients correlated with global cognitive decline (MMSE), and with executive and visuospatial test scores, showing good concurrent validity. Conclusion: The FAB does not differentiate patients with AD from those with FTD, like all other executive tests. However, it may be useful in the examination of executive function in AD, FTD and several other pathological conditions.

Cognitive modelling of face processing: evidence from Alzheimer patients

This is a prospective neuropsychological study on face processing in Alzheimers disease (AD). The aim was to assess the prevalence and the nature of face processing disorders in AD, and at investigating possible inter-test dissociations within the framework of currently used face processing models. A standardized four-test battery of unknown face discrimination and familiar face recognition was given to 30 mildly deteriorated patients with AD. Half of the patients performed below the cut-off in at least one of the tests. Deficits in familiar face recognition tests were more frequently observed than deficits in unknown face discrimination tests. There was no correlation between impairment of face processing and overall cognitive impairment or visual disorders. A multiple single case approach allowed us to elicit statistically warranted double dissociations between tasks assessing unknown face discrimination and tasks assessing familiar face recognition. Moreover, the ability to decide whether or not a stimulus is a face or a non-face has proven to be a non-mandatory step to further process the face stimuli. All together, these findings support the hypothesis that distinct pathways are involved in the processing of unknown and familiar faces, as posited by Bruce and Young [Br. J. Psychol. 77, 305-327, 1986].

When Rey-Osterrieth's Complex Figure Becomes a Church: Prevalence and Correlates of Graphic Confabulations in Dementia.

Verbal confabulation (VC) has been described in several pathological conditions characterized by amnesia and has been defined as ‘statements that involve distortion of memories’. Here we describe another kind of confabulation (graphic confabulation, GC), evident at the recall of the Rey-Osterrieth complex figure (ROCF). In a retrospective study of 267 patients with mild-to-moderate dementia, 14 patients (4.9 %) recalled the abstract ROCF as drawings with recognizable semantic meaning. VC was evident at the story recall test in 19.8% of the study participants. VC and GC were homogeneously distributed among the different types of dementia. VC has been proposed to originate from complex interactions of amnesia, motivational deficit and dysfunction of monitoring systems. On the contrary, GC seems to be the result of a deficit in visual memory replaced by the semantic translation of isolated parts of the ROCF along with a source monitoring deficit.

Degenerative Dementia of the Frontal Type

The retrospective neurological, neuroradiological and neuropsychological observation of 9 cases of dementia with frontal symptoms is reported. Aim of this paper is to contribute to the clinical corpus of data related to the frontal features of the frontotemporal dementia (FTD) syndrome, so as to support clinicians’ awareness and widen the information available for the diagnostic approach to the dementias. FTD is a clinical diagnosis which does not imply a single underlying pathology, since more than one condition can induce the syndrome. Inertia and behavioural symptoms were the traits characterizing both the onset and the progression of the disease in our patients. Progression brought to the surface behavioural and neuropsychological patterns generically traced back to frontal dysfunction. Social inadequacy was the most salient trait. From a clinical point of view frontal dementias may be regarded as a conceptually different type of dementia with respect to Alzheimer’s disease, i.e., a ‘behavioural’ as opposed to a ‘cognitive’ progressive disorder.Renal blood flow (RBF) autoregulation reappears in postischemic rat kidneys during serotonin (5-HT2) antagonism. The aim of the present study was to analyze whether 5-HT2 antagonism can ameliorate impaired RBF autoregulation in rats treated with 20 mg/kg per d cyclosporin A during 10 d. Autoregulation of RBF was assessed during stepwise lowering of renal perfusion pressure from 110 to 70 mmHg by gradual compression of the aorta. Autoregulation was lost in the cyclosporin A-treated rats. During administration of the 5-HT2 antagonist ritanserin (0.6 mg/kg intravenous bolus, followed by 1.2 mg/kg per h intravenous infusion during 1 h), autoregulation acutely reappeared. Intrarenal bolus injections of a selective 5-HT2-agonist, 2,5 dimethoxy-4-iodoamphetamine hydrochloride, elicited a significantly stronger renal vasocontraction in cyclosporin A-treated rats than in control rats. This finding was also observed with serotonin after nitric oxide-synthase blockade. These results (1) show the importance of 5-HT2-receptor-mediated vasoconstriction in the suppression of vasodilatory autoregulation of RBF in experimental cyclosporin A-induced renal dysfunction and (2) demonstrate that the complete loss of RBF autoregulation is not due to damage of the vascular smooth muscle cells.

Components in the breakdown of verbal communication in alzheimer's disease

Abstract A retrospective study was conducted on 66 Alzheimer patients and 66 age, education- and sex-matched healthy controls. The broad aim was to gain further understanding of the verbal communication disorders of Alzheimer patients by comparing two tests for their sensitivity to Alzheimers disease; namely an «active» and a «passive» oral language test; respectively a classic Semantically cued Word Generation (SWG), and a Sentence Comprehension Test, the Token Test (TT). The results show that nearly half of our Alzheimer patients are below cut-off on each test, that only a quarter were impaired both on TT on SWG (often patients impaired on one test were not impaired on the other), and that the two tests were poorly correlated in both healthy controls and Alzheimer patients. Nevertheless, the two tests have a comparable specificity in telling Alzheimer patients apart from matched healthy controls. The different processing sub-components for word generation and sentence comprehension and the impact Alzhe...

CHRNA7 Gene and Response to Cholinesterase Inhibitors in an Italian Cohort of Alzheimer's Disease Patients.

Previous studies suggest that genetic variants in CHRNA7, which encodes for the major subunit of the acetylcholine receptor (α7-nAChR), are associated with the clinical response to cholinesterase inhibitors (ChEI) in Alzheimers disease (AD) patients. We sought to replicate the association of two SNPs in the CHRNA7 gene, rs6494223 and rs8024987, with response to ChEI treatment in an Italian cohort of 169 AD patients, further extending the study to gene-level analysis. None of the tested variants was associated with clinical response. However, rs6494223 showed a consistent effect direction (OR = 1.4; p = 0.17), which after meta-analysis with previous study yielded a significant result (OR = 1.57, p = 0.02, I2 = 0%).

Multiple look-alikes delusion

Nicoletta Beschin , Roberto Cubelli , Marta Zuffi c and Sergio Della Sala d,* a Neuropsychological Service, Rehabilitation Unit, ASST Valle Olona, Somma Lombardo Hospital, Italy b Department of Psychology and Cognitive Sciences, University of Trento, Italy c Neurology Department, Multimedica Hospital-Castellanza, Italy d Human Cognitive Neuroscience, Psychology, University of Edinburgh, Edinburgh, UK