Dementia has devastating consequences for families with important physical, psychological, social, and financial effects. Evaluation of caregiver’s needs may be an important step to reduce the burden of family caregivers of dementia patients. An Austrian scale, the Carers’ Needs Assessment for Dementia, is now available for measuring the caregiver’s needs. The aim of our study was to evaluate the psychometric properties of the Italian version of the CNA-D (iCNA-D). A sample of 214 voluntary caregivers of dementia patients was recruited at the Department of Neuroscience, University of Turin (Italy). All participants were administered the iCNA-D. Validity and reliability of the instrument were evaluated using Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Checklist-90 (SCL-90), and the Italian version of Zarit Burden Interview (I-ZBI). The most common unmet need reported for the iCNA-D was “counseling and emotional support” (31.5%). This item demonstrates adequate reliability with moderate internal consistency for all “summary scores” of iCNA-D (α ≥ 0.75) and split-half correlation of more than 0.80 for two of them. We also found positive correlations in two out of three “summary scores” of iCNA-D and in the overall outcomes of BDI, BAI, SCL-90, and I-ZBI. The iCNA-D could be a valid and reliable tool for a comprehensive assessment of needs and possible social supports proposed to relatives who take care of patients with dementia. Better understanding of family caregivers’ needs could improve planning of local services and reduce caregivers’ perception of distress and burden.

Migraine is one of the most common medical disorder in the world. Metacognition is the ability to monitor one's own cognitive functioning and consequently direct one's behavior. In adult migraine patients, the neuropsychological profile has been poorly investigated, and metacognitive functions have never been assessed. The aim of the present study was therefore to evaluate executive metacognitive abilities in patients with episodic and chronic migraine. Sixty-four migraine patients (male/female = 18/46; mean age = 45.65 +/- 11.61 years): 27 patients with episodic migraine without aura (male/female = 9/18; mean age +/- SD = 45.11 +/- 12.18 years) and 37 patients with chronic migraine and medication-overuse headache (male/female = 9/28; mean +/- age SD = 46.05 +/- 11.32 years) were selected for the study. Twenty-nine controls (male/female = 12/17; mean +/- age SD = 42.86 +/- 14.78 years) were also enrolled in the research. Metacognitive and executive skills were assessed using the metacognitive version of Wisconsin Card Sorting Test, Migraine patients exhibited a lower performance in metacognitive tasks in respect to controls in term of worse outcomes in accuracy score (p = 0.012), global monitoring (p = 0.015), monetary gains (p = 0.022), and control sensitivity (p = 0.027). A reduction in accuracy score (p = 0.001), free choice improvement (p = 0.002), global monitoring (p = 0.003), monetary gains (p = 0.009), and control sensitivity (p < 0.001) was also found in patients with chronic migraine and medication-overuse headache in respect to patients with episodic migraine. Our study supports the hypothesis that migraine patients show metacognitive dysfunctions that become worse with the chronicization of the disease and the increase of medication use. (C) 2019 Elsevier Ltd. All rights reserved.

In everyday life, older adults may often find difficulties to deal situations requiring the performance of different actions simultaneously. This study investigates the walking per-formance during dual-task conditions and the possible relationship with fear of falling in a group of older adults living in a long-term care setting. Fifteen older adults (average age M = 79±10 years) carried out a walking test in single-task and the same test in different dual-task conditions. Data on the fear of falling were collected. Results showed a reduction of walking speed under dual-task condition. Moreover a performance decline over the time was observed. Significant correlations were observed between dual-task conditions and fear of falling. The results underline the difficulties during dual-task condition in old age and the relationship with the fear of falling. This information may be useful for the development of specific physical and cognitive interventions.

The primary aim of this study was to evaluate and compare the effectiveness of two specific Non-Invasive Brain Stimulation (NIBS) paradigms, the repetitive Transcranial Magnetic Stimulation (rTMS), and transcranial Direct Current Stimulation (tDCS), in the upper limb rehabilitation of patients with stroke. Short and long term outcomes (after 3 and 6 months, respectively) were evaluated. We measured, at multiple time points, the manual dexterity using a validated clinical scale (ARAT), electroencephalography auditory event related potentials, and neuropsychological performances in patients with chronic stroke of middle severity. Thirty four patients were enrolled and randomized. The intervention group was treated with a NIBS protocol longer than usual, applying a second cycle of stimulation, after a washout period, using different techniques in the two cycles (rTMS/tDCS). We compared the results with a control group treated with sham stimulation. We split the data analysis into three studies. In this first study we examined if a cumulative effect was clinically visible. In the second study we compared the effects of the two techniques. In the third study we explored if patients with minor cognitive impairment have most benefit from the treatment and if cognitive and motor outcomes were correlated. We found that the impairment in some cognitive domains cannot be considered an exclusion criterion for rehabilitation with NIBS. ERP improved, related to cognitive and attentional processes after stimulation on the motor cortex, but transitorily. This effect could be linked to the restoration of hemispheric balance or by the effects of distant connections. In our study the effects of the two NIBS were comparable, with some advantages using tDCS vs. rTMS in stroke rehabilitation. Finally we found that more than one cycle (2–4 weeks), spaced out by washout periods, should be used, only in responder patients, to obtain clinical relevant results.

Despite transient global amnesia is considered unusual in Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and causal relation is still unclear, this report suggests to consider CADASIL in those patients with recurrent transient global amnesia, especially when MRI shows multifocal hyperintensities affecting the cerebral white matter or when it is followed by cognitive decline.

Background Neurologic 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. Methods A 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 time = 42 months) and underwent neuropsychologic evaluations; data were compared with those of a matched-control group of hypertensive patients without history of cardiac operations. Results Forty-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 >30 minutes 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 (P = .003), worse semantic fluency (P = .036), higher degree of alexithymia (P = .004), and a lower quality of life (P = .007). Conclusion Although 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.

In this paper we report the effect of a combined transcranial direct current stimulation (tDCS) and speech language therapy on linguistic deficits following left brain damage in a stroke case. We show that simultaneous electrical excitatory stimulation to the left and inhibitory stimulation to the right parietal regions (dual-tDCS) affected writing and reading rehabilitation, enhancing speech therapy outcomes. The results of a comparison with healthy controls showed that application of dual-tDCS could improve, in particular, sub-lexical transcoding and, specifically, the reading of non-words with increasing length and complexity. Positive repercussions on patient's quality of functional communication were also ascertained. Significant changes were also found in other language and cognitive tasks not directly treated (comprehension and constructive apraxia).

Hereditary ataxias are a heterogeneous group of neurodegenerative disorders, where exome sequencing may become an important diagnostic tool to solve clinically or genetically complex cases.

This pilot study identified the effect and the feasibility of neuromotor training in a group of ageing women living in a long-term care setting. Thirty-five older women (mean age, 84.18 years; SD = 5.92 years) participated in the study. Twenty women were in the intervention group, and 15 women were in the control group. Data on mobility, activities of daily living (ADL) and fear of falling were collected before and after the 16-week training period. The neuromotor training program was based on concepts from motor control and motor learning. All participants completed the training program, and no adverse events occurred. The intervention group showed steady and significant improvements in mobility, ADL and fear of falling after the intervention, but the control group did not exhibit significant changes. Moreover, mediation analysis demonstrated the role of mobility as a mediator between participation in physical training and fear of falling.

AIMS:Alexithymia is a personality trait that consists of difficulty in identifying and acknowledging one's 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.METHODS:We performed a voxel-based morphometry study on 21 patients with AN and 18 with BN. Seventeen healthy subjects were used as a control group. Alexithymia, depression and anxiety were assessed with self-administered questionnaires and correlated to gray matter (GM) density in each group.RESULTS:In BN, alexithymia was correlated with the GM of the parietal lobe, in particular of the right angular gyrus. The correlation was predominantly linked with Difficulty Describing Feelings. In AN, we did not find correlations between GM and alexithymia.CONCLUSIONS:In BN, our results support the hypothesis that this trait may represent a relevant pathogenic or maintenance factor that contributes to relational difficulties, present in this pathology. In AN, the lack of correlation between GM volume and alexithymia may be influenced by atrophy in several brain regions that in turn can be, as previously reported, a consequence of caloric restriction. Also, the nature of alexithymia may be different from that of BN and controls and this trait could be secondary to a psychopathologic process specific to AN.

Objective: anorexia Nervosa (AN) is a multi-factorial disorder (sociological, psychological and biological), but we can use two important tools to better understand its psychopathology: attachment theory and modern neuroimaging techniques. in this study, we looked for the anatomical and functional correlates of the attachment system in both young women with AN and healthy controls.Method: we enrolled 18 participants - 10 patients with AN and 8 controls. the adult attachment interview (AAI) was administered to all participants to assess their state of mind with respect to attachment. all participants also underwent an mri scan (T1 weighted high resolution anatomical images and Bold resting state fMRI). we analyzed mri data using Voxel Based morphometry and voxel-wise resting state measures (standard deviation and amplitude of low-frequency fluctuations of the timecourse).Results: in our study, secure attachment was more common in controls than in AN patients. some subscales of AAI were found to be significantly different between the groups: pressure to achieve exerted by the mother was higher in AN than in controls while the scores in both coherence of mind (CoM) and coherence of transcript (CoT) scales were significantly lower. CoM and CoT positively correlated with the volume of grey matter (GM) in a network of brain areas comprising the temporal poles, both amygdalae, the midbrain, the thalamus and the anterior and middle sections of cingulate cortex. the scale measuring the love received by the mother correlated with a network largely overlapping with CoM/CoT, while anger anticorrelated with parts of the same network (for instance, the precuneus and part of the limbic system). Higher passivity correlated with lower GM volumes in a network comprising mostly mesial areas such as the precuneus.Conclusions: it seems therefore that the experience of love during childhood and the feeling of anger towards the caregivers expressed during the interview have opposite effects on brain areas: while the experience of love seems to be a protective factor, anger is correlated with lower GM volume. We conclude that non-secure attachment is a core feature of anorexia nervosa both at psychopathological and neurobiological levels.

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 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.

We describe a patient who presented with a pure topographical disorientation after a stroke involving the right mesial occipito-temporal cortex. He could not point to external unseen landmarks or draw a map of his city, while he could recognize landmarks, and judge the distance, and describe the route between pairs of landmarks of the same city. He underwent standardized cognitive tests, and 6 tasks were used to assess a topographical orientation route-survey. This study provides evidence that topographical disorientation can be subdivided into very specific components. The results suggest that one of these components might refer to the processing of an allocentric map separable from the representation of route knowledge.