Martina Ulivi

A single-center, cross-sectional prevalence study of impulse control disorders in Parkinson disease: association with dopaminergic drugs.

Abstract The current study aimed at establishing the prevalence of impulse control disorders (ICDs) in patients with Parkinson disease (PD) and their association with demographic, drug-related, and disease-related characteristics. We performed a single-center cross-sectional study of 805 PD patients. Impulse control disorders were investigated with the Questionnaire for Impulsive Compulsive Disorders in Parkinson’s Disease; also comorbid neuropsychiatric complications (dementia, delusions, visual hallucinations) were investigated with clinical interviews and ad hoc instruments (Parkinson Psychosis Questionnaire and Neuropsychiatry Inventory). Impulse control disorders were identified in 65 patients (prevalence, 8.1%), with pathological gambling and hypersexuality the most frequent. Impulse control disorders were present in 57 of 593 cognitively preserved patients (prevalence, 9.6%) and in 8 of 212 demented patients (prevalence, 3.8%). Impulse control disorders were significantly associated with dopamine agonists (odds ratio [OR], 5.50; 95% confidence interval [CI], 2.60–12.46; P < 0.0001) and levodopa (OR, 2.43; 95% CI, 1.06–6.35; P = 0.034). Impulse control disorders frequency was similar for pramipexole and ropinirole (16.6% vs 12.5%; OR, 1.45; 95% CI, 0.79–2.74; P = 0.227). Additional variables associated with ICDs were male sex and younger age. These findings suggested that dopaminergic treatments in PD are associated with increased odds of having an ICD, but also other demographic and clinical variables are associated with ICDs, suggesting the multifactorial nature of the ICD phenomenon in PD.

Repetitive and Stereotypic Phenomena and Dementia

Background: Behavioral disturbances of dementia, such as repetitive and stereotypic phenomena, can be distressing to caregivers and may lead to early institutionalization of the patient. Objective: The purpose of this article is to examine the phenomenon of repetitive phenomena in patients with dementia. Methods: We searched the PubMed electronic databases for original research and review articles on repetitive phenomena in patients with dementia using the search terms “repetitive behavior, stereotypic behavior, dementia, Alzheimer’s disease, Frontotemporal dementia.” Results: Repetitive and stereotypic phenomena are common problems in dementia, which may reflect a disruption of coordinated function within the basal ganglia or corticostriatal structures. Conclusions: There are no systematic studies concerning repetitive phenomena in patients with dementia, and very little is known about the treatment. Further studies are needed to determine the specific phenomena.

Delusional Misidentification Syndromes and Dementia A Border Zone Between Neurology and Psychiatry

The delusional misidentification syndromes (DMSs) are psychopathologic phenomena in which a patient consistently misidentifies persons, places, objects, or events. Although often described in relation to psychotic states including schzofrenia, it is, nevertheless, widely considered that these syndromes have an anatomical basis because of their frequent association with organic brain disease; studies have pointed to the presence of identifiable lesions, especially in the right frontal lobe and adjacent regions, in a considerable proportion of patients. The purpose of this article is to examine the phenomenon in people with dementia. We searched the electronic databases for original research and review articles on DMS in patients with dementia using the search terms “Delusional Misidentification Syndrome, Capgras syndrome, Fregoli syndrome, reduplicative paramnesia, and dementia.” The DMSs are a frequent problem in dementia. The violence and dangerousness in patients with dementia having these syndromes are well documented, and forensic aspects are highlighted. Pathogenetic viewpoint and management are considered.

Affective theory of mind in patients with Parkinson's disease

The aim of this study was to assess the hypothesis that patients with Parkinsons disease (PD) may have difficulties in tasks of affective theory of mind (ToM; the inference on others’ feelings) especially in moderate/advanced PD stages. Difficulties of cognitive ToM have already been described in several previous studies.

Sexual disinhibition and dementia.

To describe inappropriate sexual behaviour (ISB) observed in patients with dementia, we conducted searches using the Cochrane Library, PubMed, and Web of Science to find relevant articles, chapters, and books published from 1950 to 2014. Search terms used included ‘hypersexuality’, ‘inappropriate sexual behaviors’, and ‘dementia’. Publications found through this indexed search were reviewed for further relevant references. Sexuality is a humans need to express intimacy, but persons with dementia may not know how to appropriately meet their needs for closeness and intimacy due to their decline in cognition. Generally, the interaction among brain, physical, psychological, and environmental factors can create what we call ISB. The most likely change in the sexual behaviour of a person with dementia is indifference. However, ISB in dementia appear to be of two types—intimacy‐seeking and disinhibited—that differ in their association with dementia type, dementia severity and, possibly, other concurrent behavioural disorder. Tensions develop from uncertainties regarding which, or when, behaviours are to be considered ‘inappropriate’ (i.e. improper) or abnormal. While most ISB occur in the moderate to severe stages of Alzheimers dementia, they may also be seen in early stages of frontotemporal dementia because of the lack of insight and disinhibition. ISB are often better managed by non‐pharmacological means, as patients may be less responsive to psychoactive therapies, but non‐pharmacological interventions do not always stop the behaviour.

Triggers in allodynic and non-allodynic migraineurs. A clinic setting study.

Allodynia is considered a phenomenon of central sensitization that may lead to migraine transformation, lowering the attack threshold. Migraine triggers are factors that may induce headache attacks in susceptible individuals. We hypothesize that because allodynia decreases the migraine‐attack threshold, allodynic migraineurs are more susceptible to triggers than the non‐allodynic ones.

How Aware Are Migraineurs of Their Triggers

Broad discrepancies in the number of migraine triggers have been reported in several studies. Migraineurs do not seem to recognize easily headache triggers in clinical practice.

Uncommon and/or bizarre features of dementia

This study aimed at describing uncommon or bizarre symptoms observed in patients suffering from dementia. Medline and Google scholar searches were conducted for relevant articles, chapters, and books published since 1967. Search terms used included uncommon presentation, behavioural and psychological symptoms, dementia, Alzheimer’s disease, and fronto-temporal dementia. Publications found through this indexed search were reviewed for further relevant references. The uncommon symptoms are described as case-reports and there are no systematic investigations. Bizarre behaviours arising late in life should be thoroughly investigated as symptoms of dementia.

Peri-ictal prolonged atrial fibrillation after generalized seizures: Description of a case and etiopathological considerations

Cardiac rhythm changes are not uncommon in connection with seizures and should be considered and recognized given their potentially harmful consequences including Sudden Unexpected Death in Epilepsy (SUDEP). The most well known are ictal tachycardia and bradycardia. However, other potentially dangerous peri-ictal arrhythmias have been reported. Brief atrial fibrillation episodes, never longer than 2 min, have rarely been described in connection with seizures. We report the case of a patient who presented with two generalized tonic-clonic seizures associated with prolonged atrial fibrillation. Extensive non-invasive cardiac investigations failed to disclose cardiac abnormalities, and after proper antiepileptic drug treatment the patient had neither further seizures nor cardiac events in an 18-month follow-up. Our case, to our knowledge, is the first report of prolonged (more than 1 h) peri-ictal atrial fibrillation.

Localized Calcific Hematoma of the Scalp Presenting as a Nummular-Like Headache. A Case Report

Nummular headache (NH) is a primary headache characterized by focal head pain felt in a coin-shaped area (International Classification of Headache Disorders II, A13.7.1). Pain is typically mild to moderate, with chronic exacerbations. Headache is more frequently localized in the parietal region of the skull and sometimes, sensory symptoms, tenderness, and occasionally trophic changes may coexist, sharply bordered inside the painful area. The absence of any lesion of the underlying structures is a prerequisite for the diagnosis; nonetheless, symptomatic cases have been reported in the literature. We reported a case of an NH that we suggested as secondary to a post-traumatic localized calcific hematoma of the scalp. A 46-year-old woman presented in June 2011. The patient was a strong smoker, and in her past medical history, she had experienced an episode of major depression 15 years prior to presentation in our clinic. She reported suffering from headaches 4 years prior to presentation. The pain was tightening in quality, chronic, mild in intensity, interrupted by spontaneous remission lasting from few days to 2-3 weeks. It was localized in the right parietal region on a circumscribed round-shaped area of about 3 cm in diameter. There were no signs or symptoms of sensory dysfunction without tenderness in the symptomatic area. The pain was not associated with nausea, vomiting, photophobia, phonophobia, or autonomic signs. During the last 6 months, she noted a modification of the headache pattern. The pain became continuous, moderate with some severe exacerbations lasting for 1-2 hours and was characterized as “throbbing.” The exacerbations may be triggered by emotive stress.The headache responded quite well at low doses of ibuprofen or ketoprofen. Over the year prior to the onset of headaches, she reported repeated trivial head trauma against a shelf placed behind her desk, always approximately on the scalp region of the origin of pain. This occurred because of the constricted space in which she worked. The issue of a lack of space was exacerbated by having to move away from the space in a hurry with some degree of frequency. At the patient’s physical evaluation, the scalp inspection demonstrated a bump in the painful region without trophic alteration. The neurological examination was completely negative. Scalp ultrasound, skull computed tomography, also with 3-dimensional reconstructions, and brain magnetic resonance imaging were performed and showed the presence of a lesion of about 10.5 mm, with a calcific component and a liquid layer that discloses the epicranial tissues. This lesion, compatible with a calcific hematoma, was localized exactly in the same site, the pain area fingerpointed by the patient presenting a spatial relationFrom the Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy (M. Ulivi, F. Baldacci, A. Vergallo, and U. Bonuccelli), Neurology Unit, Hospital of Viareggio, Viareggio, Italy (M. Vedovello, P. Borelli, and A. Nuti). Conflict of Interest: In the past year, Ubaldo Bonuccelli has received fees for consultation from GSK and Eisai, and for speeches from Novartis, GSK, and Lundbeck. The remaining authors report no conflict of interest. ISSN 0017-8748 doi: 10.1111/head.12131 Published by Wiley Periodicals, Inc. Headache