Petronilla Battista

Computerized Neuropsychological Assessment in Aging: Testing Efficacy and Clinical Ecology of Different Interfaces

Digital technologies have opened new opportunities for psychological testing, allowing new computerized testing tools to be developed and/or paper and pencil testing tools to be translated to new computerized devices. The question that rises is whether these implementations may introduce some technology-specific effects to be considered in neuropsychological evaluations. Two core aspects have been investigated in this work: the efficacy of tests and the clinical ecology of their administration (the ability to measure real-world test performance), specifically (1) the testing efficacy of a computerized test when response to stimuli is measured using a touch-screen compared to a conventional mouse-control response device; (2) the testing efficacy of a computerized test with respect to different input modalities (visual versus verbal); and (3) the ecology of two computerized assessment modalities (touch-screen and mouse-control), including preference measurements of participants. Our results suggest that (1) touch-screen devices are suitable for administering experimental tasks requiring precise timings for detection, (2) intrinsic nature of neuropsychological tests should always be respected in terms of stimuli presentation when translated to new digitalized environment, and (3) touch-screen devices result in ecological instruments being proposed for the computerized administration of neuropsychological tests with a high level of preference from elderly people.

Frontiers for the Early Diagnosis of AD by Means of MRI Brain Imaging and Support Vector Machines

The emergence of Alzheimers Disease (AD) as a consequence of increasing aging population makes urgent the availability of methods for the early and accurate diagnosis. Magnetic Resonance Imaging (MRI) could be used as in vivo, non invasive tool to identify sensitive and specific markers of very early AD progression. In recent years, multivariate pattern analysis (MVPA) and machine- learning algorithms have attracted strong interest within the neuroimaging community, as they allow automatic classification of imaging data with higher performance than univariate statistical analysis. An exhaustive search of PubMed, Web of Science and Medline records was performed in this work, in order to retrieve studies focused on the potential role of MRI in aiding the clinician in early diagnosis of AD by using Support Vector Machines (SVMs) as MVPA automated classification method. A total of 30 studies emerged, published from 2008 to date. This review aims to give a state-of-the-art overview about SVM for the early and differential diagnosis of AD-related pathologies by means of MRI data, starting from preliminary steps such as image pre-processing, feature extraction and feature selection, and ending with classification, validation strategies and extraction of MRI-related biomarkers. The main advantages and drawbacks of the different techniques were explored. Results obtained by the reviewed studies were reported in terms of classification performance and biomarker outcomes, in order to shed light on the parameters that accompany normal and pathological aging. Unresolved issues and possible future directions were finally pointed out.

Excitatory Deep Transcranial Magnetic Stimulation With H-Coil Over the Right Homologous Broca’s Region Improves Naming in Chronic Post-stroke Aphasia:

Background. The role of the right hemisphere in poststroke aphasia recovery is still controversial and the effects of repetitive transcranial magnetic stimulation (rTMS) over the right homologous Broca’s region have been seldom investigated. Objective. This study aimed to compare the effect of excitatory, inhibitory, and sham rTMS delivered with H-coil over the right inferior frontal gyrus in chronic aphasic patients. Methods. Five right-handed poststroke aphasic patients underwent a picture naming task before and immediately after each of 3 sessions of rTMS: excitatory (10 Hz), inhibitory (1 Hz), and sham rTMS, in random sequence and separated by at least 1 week. Results. Only the excitatory 10-Hz stimulation was associated with a significant improvement in naming performance (P = .043) and was significantly more effective than 1-Hz rTMS (P = .043). Conclusions. A single session of excitatory deep brain rTMS over the right inferior frontal gyrus with H-coil significantly improves naming in right-handed chronic poststroke aphasic patients. This result is in line with the hypothesis of a positive, rather than detrimental, role of the right hemisphere in chronic aphasia due to a left-hemispheric stroke.

Optimizing Neuropsychological Assessments for Cognitive, Behavioral, and Functional Impairment Classification: A Machine Learning Study

Subjects with Alzheimers disease (AD) show loss of cognitive functions and change in behavioral and functional state affecting the quality of their daily life and that of their families and caregivers. A neuropsychological assessment plays a crucial role in detecting such changes from normal conditions. However, despite the existence of clinical measures that are used to classify and diagnose AD, a large amount of subjectivity continues to exist. Our aim was to assess the potential of machine learning in quantifying this process and optimizing or even reducing the amount of neuropsychological tests used to classify AD patients, also at an early stage of impairment. We investigated the role of twelve state-of-the-art neuropsychological tests in the automatic classification of subjects with none, mild, or severe impairment as measured by the clinical dementia rating (CDR). Data were obtained from the ADNI database. In the groups of measures used as features, we included measures of both cognitive domains and subdomains. Our findings show that some tests are more frequently best predictors for the automatic classification, namely, LM, ADAS-Cog, AVLT, and FAQ, with a major role of the ADAS-Cog measures of delayed and immediate memory and the FAQ measure of financial competency.

SAND: a Screening for Aphasia in NeuroDegeneration. Development and normative data

Language assessment has a critical role in the clinical diagnosis of neurodegenerative diseases, in particular, in the case of Primary Progressive Aphasia (PPA). The current diagnostic criteria (Gorno-Tempini et al., 2011) identify three main variants on the basis of clinical features and patterns of brain atrophy. Widely accepted tools to diagnose, clinically classify, and follow up the heterogeneous language profiles of PPA are still lacking. In this study, we develop a screening battery, composed of nine tests (picture naming, word and sentence comprehension, word and sentence repetition, reading, semantic association, writing and picture description), following the recommendations of current diagnostic guidelines and taking into account recent research on the topic. All tasks were developed with consideration of the psycholinguistic factors that can affect performance, with the aim of achieving sensitivity to the language deficit to which each task was relevant, and to allow identification of the selective characteristic impairments of each PPA variant. Normative data on 134 Italian subjects pooled across homogeneous subgroups for age, sex, and education are reported. Although further work is still needed, this battery represents a first step towards a concise multilingual standard language examination, a fast and simple tool to help clinicians and researchers in the diagnosis of PPA.

Primary progressive aphasia: a review of neuropsychological tests for the assessment of speech and language disorders

ABSTRACT Background: Speech and language impairments are the key clinical feature in several neurodegenerative disorders and primary progressive aphasia (PPA) is the syndrome where they are the prominent features. Their accurate and early identification may increase the diagnosis in the clinical setting. This approach may allow a better discrimination between the different neurodegenerative disorders and the PPA variants, i.e., nonfluent, semantic, logopenic. Aims: The aim of this work is twofold: (1) to provide an overview of the available neuropsychological tests for the diagnosis of PPA and/or for the differentiation among the PPA variants and (2) to evaluate the methodological quality and the psychometric characteristics of these tests. Methods & Procedures: This review was conducted following PRISMA guidelines. Search terms were chosen based on the research questions and used in a search in two databases. Then, inclusion criteria were formulated and papers meeting the criteria were reviewed. The methodological quality of the studies was evaluated examining the following items: (1) blindness of personnel, (2) consecutive inclusion of patients, and (3) representativeness of the sample. Outcomes & Results: A total of 907 papers have been selected from the databases, and 9 of them were included in this review. Among these, three tests aimed to differentiate between PPA variants, two tests were designed for the assessment of language disorders in PPA patients, and four tests were developed to stage the severity of speech/language disorders in PPA patients. All the included studies provided psychometric data about the clinical validity of the tests; however, they present several limitations, both psychometric and methodological. Conclusion: The number of validation studies is still limited. This brief review reveals the need of linguistically sophisticated tests, characterized by better quality of methods and psychometric characteristics, to be used to systematically evaluate the linguistic abilities of individuals with PPA.

Screening for Aphasia in NeuroDegeneration for the Diagnosis of Patients with Primary Progressive Aphasia: Clinical Validity and Psychometric Properties

Background: We evaluated the psychometric proprieties of the Screening for Aphasia in NeuroDegeneration (SAND) battery in Italian primary progressive aphasia (PPA) and movement disorder (MD) patients. Methods: The sample included 30 consecutive PPA and 45 MD patients who completed the SAND battery together with a clinical interview and a neurological/neuropsychological examination and 130 healthy controls (HC). Results: The SAND battery showed good internal consistency and good convergent and divergent validity. receiver operating characteristic analysis revealed an area under the curve of 0.978 for PPA versus HC and of 0.786 for PPA versus MD. A cutoff ≥3 gave a sensitivity of 0.933% and a specificity of 0.946% for discriminating PPA versus HC, whereas a cutoff ≥5 gave a sensitivity of 0.767% and a specificity of 0.667% for discriminating PPA versus MD. Conclusion: These results indicate that the SAND battery is an adequate, reliable, and valid diagnostic tool for PPA.