OBJECTIVE:Accurate cognitive screening tests for culturally, linguistically, and educationally diverse populations remain scarce, contributing to diagnostic inequities. To address this, we examined the cross-cultural properties and diagnostic accuracy of the Multicultural Cognitive Examination (MCE) in classifying mild cognitive impairment (MCI), dementia, Alzheimer's disease (AD) dementia, and non-AD dementia in participants with diverse backgrounds. METHOD:In this retrospective cross-sectional study, we aggregated data from 1,449 participants across 11 countries. Multiple linear regression models were used to determine the influence of demographic variables on MCE scores, which informed the creation of regression-based normative data. Diagnostic accuracies were examined using Receiver Operating Characteristics (ROC) curves. RESULTS:The cohort consisted of 1001 cognitively intact participants, 140 patients with MCI, and 308 patients with dementia. 54.2% had immigrant backgrounds and originated from 63 different countries. MCE scores were significantly influenced by education and age, but not by sex or immigrant status. The MCE demonstrated high accuracy in differentiating cognitively intact participants from patients with dementia (AUC: .95) and MCI (AUC: .84). The MCE was both accurate for classifying AD dementia (AUC: .97) and non-AD dementia (AUC: .94). CONCLUSIONS:This study supports the clinical utility of the MCE as a culturally robust and highly accurate cognitive screening test. Future studies should examine the ability of the MCE to monitor cognitive decline.

Background Brief and accurate tools are needed to enhance the prompt identification of cognitive disorders. This study aimed to translate and adapt two recently developed, highly accurate instruments into Italian: the Brief Assessment of Impaired Cognition (BASIC) and the BASIC Questionnaire (BASIC-Q), and to validate their diagnostic accuracy. Methods The Italian versions of BASIC and BASIC-Q were developed following a rigorous process and were validated in patient populations referred to two Italian tertiary memory clinics. Receiver operating characteristic curve analysis was used to evaluate the discriminative validity of BASIC and BASIC-Q in identifying cognitive impairment compared to specialist diagnoses. Linear regression models were used to explore the influence of traditional confounders, such as age and education. Results A total of 246 participants were recruited for the study. The BASIC and BASIC-Q assessments accurately distinguished between individuals with cognitive impairment and those with intact cognition, achieving areas under the curve of 0.96 and 0.95, respectively. The accuracy of these two tools was comparable to that of the Mini-Mental State Examination. Additionally, both instruments showed a negative association with age but were not influenced by educational level. Discussion The BASIC and BASIC-Q tools effectively identify older individuals with cognitive impairment who may need further diagnostic assessment. Their accuracy must be explored in primary care settings and among multicultural populations.

INTRODUCTION:Early cognitive screening, although recommended, can be challenging in acute stroke settings. In patients with acute stroke, we aimed to evaluate (1) reasons and predictors of non-applicability of the Montreal Cognitive Assessment (MoCA) and (2) MoCA score performance, focusing on sex-related differences. PATIENTS AND METHODS:We conducted a single-centre study on patients consecutively admitted to our stroke unit (June 2019-June 2023). Reasons for MoCA non-applicability and MoCA scores were compared between sexes. Univariate and multivariable analyses explored associations between MoCA applicability and sociodemographic/clinical characteristics. RESULTS:Out of 637 admitted patients (median age 78.8 years; 54.3% male; 81.2% ischemic stroke), 445 (69.8%) completed the MoCA (76.3% of males, 62.2% of females, P <.001). Reasons for non-applicability were acute stroke-related in 63.5% of cases (mainly altered consciousness and aphasia), prestroke conditions-related in 22.9% and other (refusal/unreported) in 13.5%. Stroke-related reasons were more frequent in females (P =.002) and refusal in males (P =.005). Variables associated with MoCA non-applicability were: NIHSS on admission in both females (adjusted odds ratio [adj.OR] 1.25, 95% CI, 1.16-1.34) and males (adj.OR 1.24, 95% CI, 1.14-1.34); pre-stroke mRS in females (adj.OR 1.58, 95% CI, 1.15-2.17) and years of education and left-hemisphere lesion in males (adj.OR 0.91, 95% CI, 0.84-1.00 and adj.OR 2.38, 95% CI, 1.16-4.86, respectively). Among tested patients, females showed lower raw and adjusted MoCA scores (P <.001 and P =.022, respectively). CONCLUSION:Sex-specific factors influence feasibility and interpretation of early cognitive screening in the acute stroke phase: recognising these differences might guide future efforts towards more inclusive and individualised protocols.

BackgroundWith the changing demographic landscape in most countries worldwide, accurate and brief culture-sensitive case-finding instruments are needed to identify patients with possible cognitive disorders.ObjectiveTo investigate the discriminative validity of the Brief Assessment of Impaired Cognition (BASIC) and BASIC Questionnaire (BASIC-Q) in a multicultural memory clinic sample across six European countries.MethodsThe study was a European cross-sectional multi-center study. Receiver operating characteristic curve analysis was used to examine discriminative validity of BASIC and BASIC-Q in identifying cognitive impairment (mild cognitive impairment (MCI) or dementia) as compared to specialist diagnosis. Regression analysis was used to assess the influence of sociodemographic variables and assessment in a second language on scores.ResultsThe study included a total of 479 participants of which 169 (36%) had immigrant background. BASIC and BASIC-Q had high diagnostic accuracy for cognitive impairment (MCI or dementia) with areas under the curve (AUC) of 0.93 and 0.92, respectively. Age had a significant, but small effect on BASIC, while both BASIC and BASIC-Q were unaffected by sex, education, immigrant status, and assessment in a second language. Among patients with affective/anxiety disorder, 80% scored below cutoff for cognitive impairment on BASIC and 94% on BASIC-Q. However, applying an Objective Performance vs. Subjective Complaints ratio to differentiate between patients with cognitive impairment and affective/anxiety disorder resulted in high overall classification accuracies, with AUC values of 0.80 and 0.74, respectively.ConclusionsThe present study suggests that BASIC and BASIC-Q are valid brief case-finding instruments for cognitive impairment in a multicultural setting.

Objective: Dementia diagnosis relies on assessing functional decline, yet widely used assessment tools are often developed in Euro-American contexts, limiting their cross-cultural validity. This commentary highlights key challenges in functional assessment across cultures and proposes a framework for enhancing their applicability and equity.Method: We critically examine methodological limitations in current functional assessment tools, including poor cultural adaptability, inadequate validation processes, and limited stakeholder engagement. Drawing on existing literature, we propose a multidimensional framework integrating cultural perceptions, robust adaptation strategies, and participatory approaches to improve assessment relevance.Conclusions: Functional assessments must balance cultural specificity with broad applicability to ensure accurate dementia detection across diverse populations. Identifying transcultural markers of functional decline, engaging local communities, and systematically adapting tools through rigorous validation will enhance their diagnostic utility. A culturally inclusive approach to functional assessment can reduce disparities in dementia diagnosis and care worldwide.

BackgroundAlzheimer's disease and other dementias are major causes of disability and death among older adults. With an increasing number of older migrants in Italy, dementia prevalence in this group is expected to rise. However, little is known about their health outcomes.ObjectiveThis study aimed to analyze mortality in migrants with dementia in Lazio, Italy, as part of the ImmiDem project (GR-2021-12372081).MethodsA cohort study was conducted on individuals aged ≥50 with dementia living in Lazio as of December 31, 2018, who were followed for 5 years. Migratory status was defined by country of birth: native Italians, migrants from High Migratory Pressure Countries (HMPCs), or Highly Developed Countries (HDCs). Age-standardized mortality proportion was calculated by migratory status, and time-to-event analysis was performed using Cox regression models.ResultsAs of December 31, 2018, 38,380 individuals with dementia lived in Lazio, with 2.1% born in HMPCs and 0.9% in HDCs. The age-standardized mortality proportion was lower in migrants born in HPMCs (30.7%; 95% CI: 26.4-35.8) than among natives (36.8%; 95% CI: 35.4-38.4). The age- and sex-adjusted hazard ratio (HR) confirmed lower mortality in migrants (HMPCs HR = 0.91, 95% CI:0.82-1; HDCs HR = 0.79, 95% CI:0.68-0.91) than natives.ConclusionsMigrants with dementia showed lower mortality than Italians, possibly due to health advantages, salmon bias, or migration dynamics. However, these findings may not accurately reflect better health status. Potential underdiagnosis of dementia and the use of country of birth as a proxy for migratory status may have influenced results and should be considered in future research.

INTRODUCTION:Post-stroke depressive symptoms are heterogeneous and variably associated with other psycho-cognitive features. We employed cluster analysis to identify distinct profiles of post-stroke depressive symptomatology and their association with cognitive performance. METHODS:We included consecutive patients undergoing neuropsychiatric evaluation 6 months after stroke. Cluster analysis incorporated the Center for Epidemiologic Studies Depression Scale, along with the apathy and anxiety items from the Neuropsychiatric Inventory questionnaire. Baseline clinical/neuroimaging variables and 6-months cognitive outcomes were compared across profiles. RESULTS:We included 189 patients with acute cerebrovascular events (median age 75.4 years, 62% male, 80% ischemic strokes). Three profiles emerged: (A) low-depressive symptoms (n = 108), (B) moderate-depressive symptoms plus anxiety (n = 41), (C) high-depressive symptoms plus apathy (n = 40). Regarding baseline predictors of 6-month depressive symptoms profiles, patients with high-depressive symptoms plus apathy exhibited lower Montreal Cognitive Assessment scores at baseline (16.0 vs. 21.5; adjusted odds ratio [adj.OR] per 1-point increase 0.91, 95% confidence interval [95% CI] 0.83-0.99) compared to patients with low-depressive symptoms; moderate-depressive symptoms plus anxiety patients had less cortical atrophy compared to both low-depressive symptoms (adj.OR 0.92, 95% CI 0.86-0.99) and high-depressive symptoms plus apathy (adj.OR 0.89, 95% CI 0.81-0.97) profiles. Regarding 6-month cognitive performance, high-depressive symptoms plus apathy patients showed higher rates of post-stroke dementia and attention/executive function impairment compared with the two other groups (both p < 0.05), and higher rates of language impairment compared with low-depressive symptoms profile (p < 0.05). CONCLUSION:By integrating apathy and anxiety in our model, depressive symptoms after stroke emerged as heterogeneous neuropsychiatric syndromes, showing different baseline predictors and distinctive cognitive patterns.

Harmonized neuropsychological assessment for neurocognitive disorders (NCDs) is an urgent priority in clinics. Neuropsychology assessments in NCDs seldom include tests exploring social cognitive skills. In 2022, we launched the SIGNATURE initiative to optimize socio-cognitive assessment in NCDs. Here, we report findings from the first initiative phase, including consortium creation and evaluation of the state of the art in socio-cognitive assessment in memory clinics. We developed an ad hoc online survey to explore practices and measures, relevance, and obstacles preventing the use of socio-cognitive testing in clinics. The survey was distributed within the SIGNATURE network. National coordinators were identified to disseminate the survey to local collaborators and scientific societies active in the field of dementia and/or neuropsychology. Data were analysed in aggregate form and stratified by geographical area and variables of interest. Four hundred and thirteen (413) responses from 10 European and Latin American geographical regions were recorded. Responders were balanced between physicians and psychologists. Seventy-eight (78) % of respondents reported no/limited experience with socio-cognitive measures; more than 85% agreed on their relevance in clinics. Ekman-60 faces was the most well-known and/or used task, followed by the Faux-Pas and Reading-the-Mind-in-the-Eyes tests. Lack of clinical measures, assessment time, guidelines, and education/training were reported as main obstacles. Real-life barriers prevent the adoption of socio-cognitive testing in clinics. Bidirectional collaboration between clinicians and researchers is required to address clinical needs and constraints and facilitate consistent socio-cognitive assessment.

BackgroundBehavioral and psychological symptoms of dementia (BPSD) have poorly understood pathological/morphological correlates.ObjectiveWe aimed to (1) investigate the perception of the utility of different biomarkers in the assessment of BPSD among Italian Memory Clinics and (2) review current literature in this regard.MethodsA multicenter, national survey was launched by the BPSD Study Group of the Italian Neurological Society for Dementia (SINdem). Participants completed a semi-structured questionnaire on their perception of possible associations between the occurrence/severity of different BPSD and different biomarkers, based on their individual knowledge and clinical experience, regarding any type and severity of cognitive impairment. Then, we performed a systematic review according to PRISMA guidelines. Only papers reporting biomarkers correlates of BPSD in neurocognitive disorders were included.ResultsAmong the 53 responders, 94%, 68%, 68%, and 45% perceived neuropsychological testing, MRI, FDG-PET, and EEG, respectively, associated with the total amount of BPSD. EEG alterations were perceived selectively associated with nighttime behavior disturbances and psychosis cluster (p < 0.01). Hallucinations, apathy and delusions were perceived as more correlated with biomarkers. Years of experience using biomarkers for diagnosis were associated with a more selective use of topographical biomarkers (p < 0.01). 91% of participants consider useful increasing the use of biomarkers to predict the occurrence/severity of BPSD. The literature review identified 99 eligible studies. Brain MRI (60 articles) and FDG-PET (12 studies) alterations are the most associated with BPSD.ConclusionsIn clinical practice, topographical biomarkers related to regional consequences of the pathology are perceived as potentially informative in the BPSD's assessment.

BACKGROUND AND PURPOSE:Post-COVID-19 condition (PCC) is a prevalent and high-burden sequela of SARS-CoV-2 infection. Because of the complexity of its manifestations, PCC case definition currently lacks standardisation and reproducibility. We aimed to devise a simple screening tool to boost reproducibility and comparability of PCC case definition across PCC studies, and to provide a framework in which to reliably identify suspected PCC cases. We also developed a comprehensive assessment protocol based on the most frequently reported PCC characteristics. METHODS:Within a European multi-centre study and based on the conclusions of a previous systematic review, we devised a checklist to assess the presence of PCC-associated symptoms and their temporal relationship with COVID-19. RESULTS:The checklist was developed to include three symptom cores (cognitive, psychiatric, and general). For each symptom, onset is assessed within 3 months after COVID-19 resolution and persistence for at least 2 months. Any symptom fulfilling this criterion is sufficient to prompt suspicion of PCC. At least one symptom is required in the cognitive or psychiatric domains to suspect PCC with neuropsychiatric involvement. Our protocol features an extensive neuropsychological evaluation and self-administered scales for mood, anxiety, stress-related symptoms, sleep disorders, quality of life, disability, mental health, and personality traits; scales for quantitative assessment of fatigue and headache are also included. CONCLUSIONS:Consistent identification of PCC cases is crucial to correctly include patients in research and clinical studies. We propose a simple, reproducible, and flexible screening tool and a proposal for a comprehensive assessment that could be employed to enhance standardisation and comparability.

Objective. Cognitive and psychiatric symptoms are frequently reported after SARS-CoV-2 infection, but their interplay has been only partially explored. We investigated frequency and severity of psychiatric symptoms in patients with persistent cognitive complaints after COVID-19. Methods. We conducted a cross-sectional study. Neurologists assessed 101 patients reporting cognitive symptoms after COVID-19. Patients were invited to fill a screening battery with self reported psychometric scales (Depression Anxiety Stress Scales-21, Impact of Event Scale Revised, Insomnia Severity Index). Patients scoring above validated cut-offs in >= 1 scale were referred to psychiatrists who administered the Mini-International Neuropsychiatric Interview (M.I.N.I.), Hamilton Anxiety (HAM-A), and Hamilton Depression (HAM-D) rating scales and asked to complete the Personality Inventory for DSM-5-Brief Form (PID-5-BF). Results. Out of the 57 referred patients, 38 (64.4%) accepted to undergo the psychiatric examination. Among these, 18 (47.4%) were diagnosed with adjustment disorder (23.7%), anxiety disorder (10.5%), major depressive disorder (7.9%), and post-traumatic stress disorder (2.6%). Pharmacologic treatment before post-COVID condition (present in 12 patients, 31.6%) was associated with a score above cut-off on the HAM-A and HAM-D scales. A longer duration of untreated psychiatric illness after COVID-19 was associated with worse scores on the same scales. Patients with a higher PID-5-BF total score had a higher probability of receiving a psychiatric diagnosis. Conclusion. Almost half of patients with post-COVID-19 conditions reporting cognitive symptoms were found to suffer from a psychiatric condition after psychiatric evaluation. The application of a psychiatric screening in a population suffering from long-term effects of COVID-19 can lead to early diagnosis and timely treatment

OBJECTIVE:Cognitive and psychiatric symptoms have been increasingly reported after severe acute respiratory syndrome coronavirus 2 infection, developing soon after infection and possibly persisting for several months. We aimed to study this syndrome and start implementing strategies for its assessment. METHODS:Consecutive patients, referred by the infectious disease specialist because of cognitive complaints after COVID-19, were neurologically evaluated. Neurological evaluation included a cognitive screening test (Montreal Cognitive Assessment, MoCA). Moreover, patients were invited to fill out a general symptom questionnaire and a self-administered multidimensional assessment of psychiatric symptoms, followed by a full psychiatric assessment if scores were above validated cutoffs. RESULTS:Of 144 referred patients, 101 (mean age 55.2±13.1, 63.4% females) completed the cognitive screening and the self-administered psychiatric questionnaire. Acute infection severity was low for most patients and the most common persisting symptoms were fatigue (92%), sleep problems (69.5%), and headache (52.4%). MoCA outlined cognitive deficits in ≥1 cognitive domain in 34% of patients, mainly in memory and attention. About 60% of patients presented depressive, anxiety, or stress-related symptoms. Psychiatric scale scores significantly correlated with overall symptom burden and MoCA score. No significant correlation was found between MoCA scores and overall symptom burden. CONCLUSION:We hypothesize that persistent cognitive complaints after COVID-19 might reflect a concomitant or reactive psychopathological condition, possibly coupled with an infection-related impact on cognitive functions. The application of a combined neurological and psychiatric assessment seems crucial to appraise the nature of post-COVID-19 condition.

BACKGROUND:Some patients with stroke have prestroke cognitive impairment (pre-SCI), but its etiology is not clear. The aim of this cross-sectional study was to assess the frequency of pre-SCI and its association with premorbid neuropsychiatric, functional, and neuroimaging features. METHODS:Patients hospitalized in stroke unit with an informant who could complete IQCODE (Informant Questionnaire for Cognitive Decline in the Elderly) were included. Pre-SCI was diagnosed if the IQCODE score was >3.3. Prestroke assessment also included NPI-Q (Neuropsychiatric Inventory Questionnaire), the basic Activities of Daily Living and Instrumental Activities of Daily Living scales, and the Clinical Dementia Rating scale. A multivariate logistic regression model was used to evaluate the association of pre-SCI with age, sex, education, arterial hypertension, atrial fibrillation, white matter lesions, cerebral microbleeds, and pathological medial temporal lobe atrophy. RESULTS:IQCODE was available in 474 of 520 patients (91.2%; 45% women; mean age 75.5 +/- 13.3 years). Pre-SCI had a prevalence of 32.5% and was associated with prestroke NPI-Q (pre-SCI absent versus present, 1.7 +/- 2.3 versus 5.5 +/- 4.9; P<0.001), Activities of Daily Living scale (0.3 +/- 0.8 versus 1.8 +/- 1.9; P<0.001), Instrumental Activities of Daily Living scale (0.6 +/- 1.3 versus 3.8 +/- 4.0; P<0.001), and Clinical Dementia Rating scale score (0.7 +/- 1.7 versus 7.2 +/- 6.2; P<0.001). In the 271 patients with a magnetic resonance imaging available, the multivariate logistic regression showed that age (odds ratio [OR], 1.05 [95% CI, 1.62-9.73]), white matter lesions (OR, 1.26 [95% CI, 1.003-1.58]), and a pathological medial temporal lobe atrophy score (OR, 3.97 [95% CI, 1.62-9.73]) were independently associated with pre-SCI. In the 218 patients with ischemic stroke, white matter lesions (OR, 1.34 [95% CI, 1.04-1.72]) and medial temporal lobe atrophy (OR, 3.56 [95% CI, 1.38-9.19]), but not age, were associated with pre-SCI. CONCLUSIONS:One-third of patients admitted to a stroke unit have pre-SCI that is associated with preexisting neuropsychiatric symptoms and functional performance. White matter lesions and medial temporal lobe atrophy are associated with pre-SCI, suggesting that both small vessel disease and neurodegeneration might be involved in its etiology.

(1) Background: Spatial cognition (SC) is one of the earliest cognitive domains to be impaired in the course of Alzheimer’s disease (AD), resulting in spatial disorientation and becoming lost even in familiar surroundings as later dementia symptoms. To date, few studies have identified initial alterations of spatial navigation (SN) in the premorbid AD phase by real-world paradigms, and none have adopted an innovative technological apparatus to better detect gait alterations as well as physiological aspects correlated to spatial disorientation (SD). The present study aimed at exploring initial SN defects in patients with prodromal AD via a naturalistic task by using a sensory garment. (2) Methods: 20 community-dwelling patients with Mild Cognitive Impairment (MCI) due to AD and 20 age/education controls were assessed on their sequential egocentric and allocentric navigation abilities by using a modified version of the Detour Navigation Test (DNT-mv). (3) Results: When compared to controls, patients with MCI due to AD exhibited higher wrong turns (WT) and moments of hesitation (MsH) in the DNT-mv, reflecting difficulties both in sequential egocentric and allocentric navigation, depending on hippocampal deterioration. Moreover, they reported more complaints about their SN competencies and lower long-term visuospatial memory abilities than controls. Remarkably, WTs and MsH manifested in the allocentric naturalistic task of the DNT-mv were associated with autonomic nervous system alteration pertaining to cardiac functioning in the whole sample. (4) Conclusions: Naturalistic navigation tests of hippocampal function using a continuous non-invasive monitoring device can provide early markers of spatial disorientation in patients with MCI due to AD. Future studies should develop cognitive remediation techniques able to enhance SC residual abilities in patients at high risk of conversion into dementia and ecological paradigms to be replicated on a large scale.

INTRODUCTION:In recent years, the number of migrants referred to centres for cognitive disorders and dementias has increased. The aim of this study was to provide information on the provision of care for migrants with dementia through the perceptions and experiences of the professionals and caregivers involved. METHODS:The study is an exploratory qualitative research. Between 2020 and 2021, three focus group, involving caregiver and professionals were organized. RESULTS:The study explored several areas of care provision including needs, cultural representation of dementia, strengths and weaknesses and opportunities for improvement in care provision. DISCUSSION AND CONCLUSIONS:The perceptions of people directly involved in dementia care provide critical insights into the functioning of the care system, capturing nuances that standard care practices may overlook. Disorientation between services, language barriers and cultural representations of the disease are the main obstacles to continuity of care. A more holistic approach, which also addresses the emotional and social implications of dementia, is essential in ensuring equitable, timely and culturally sensitive care.

Background: Spatial navigation deficits are reported as early symptoms of Alzheimer’s disease (AD) alongside episodic memory ones. The aim of the present study was to ascertain whether neuropsychological deficits of visuospatial long-term memory can predict behavioral alterations during the navigation of older adults in novel urban environments along the normal aging–dementia continuum of the Alzheimer’s type. Methods: A total of 24 community-dwelling patients with Mild Cognitive Impairment (MCI) due to AD, 27 individuals with subjective cognitive decline (SCD), and 21 healthy controls were assessed in terms of their sequential egocentric and allocentric navigation abilities by using a modified version of the Detour Navigation Test, and neuropsychologically tested by the Corsi learning suvra-span (CLSS) test. Generalized linear models were adopted to verify whether the scores obtained by the three groups in the CLSS test predicted wrong turns and moments of hesitation during the navigation task, with the results presented as topographical disorientation scores. Results: Higher scores in the CLSS test predicted fewer wrong turns (b = −0.05; z = −2.91; p = 0.004; net of between-groups differences) and moments of hesitation for patients with MCI due to AD (b = −0.14; z = −2.43; p = 0.015), and individuals with SCD (b = −0.17; z = −3.85; p < 0.001). Conclusions: Since the CLSS test has been reported to be a reliable measure of ecological navigational abilities in the progression towards AD dementia, we recommend its use in clinical practice and highlight implications for future research.

Background: Beyond memory deterioration, spatial disorientation may occur along the continuum of normal aging—dementia of Alzheimer’s type. The present study aims at detecting behavioral disorders of spatial cognition in prodromal Alzheimer’s disease (AD) and verifying the association between Apolipoprotein E-ε4 (ApoE-ε4) genotype and gait patterns during a real-world naturalistic task. Methods: A sample of 58 elderly participants, of which 20 patients with mild cognitive impairment with CFS biomarker evidence of AD, 23 individuals with subjective cognitive decline (SCD), and 15 healthy controls (HCs), was tested by a modified version of the Detour Navigation Test (DNT-mv). Generalized linear models were run to explore the association between group belonging and wrong turns (WTs)/moments of hesitation (MsH) as behavioral disorientation scores of the DNT-mv as well as the effect of ApoE-ε4 genotype on time and walking speed registered by a smartphone app providing GPS tracking of body movement around urban environments. Results: Patients with MCI due to AD reported more WTs than individuals with SCD and HCs. Further, the ApoE-ε4 genotype determined a lower capacity in spatial information processing, influencing gait during naturalistic spatial navigation tasks. Conclusions: Behavior alterations of spatial cognition can be detected ecologically in prodromal AD. The use of technological solutions supporting gait analysis may help in corroborating the experimental observation.

Spatial navigation (SN) has been reported to be one of the first cognitive domains to be affected in Alzheimer’s disease (AD), which occurs as a result of progressive neuropathology involving specific brain areas. Moreover, the epsilon 4 isoform of apolipoprotein-E (APOE-ε4) has been associated with both sporadic and familial late-onset AD, and patients with mild cognitive impairment (MCI) due to AD are more likely to progressively deteriorate. Spatial navigation performance will be examined on a sample of 76 community-dwelling senior citizens (25 healthy controls; 25 individuals with subjective cognitive decline (SCD); and 26 patients with MCI due to AD) via a virtual computer-based task (i.e., the AppleGame) and a naturalistic task (i.e., the Detour Navigation Test—modified version) for which a wearable device with sensors will be used for recording gait data and revealing physiological parameters that may be associated with spatial disorientation. We expect that patients with MCI due to AD and APOE-ε4 carriers will show altered SN performances compared to individuals with SCD and healthy controls in the experimental tasks, and that VR testing may predict ecological performance. Impaired SN performances in people at increased risk of developing AD may inform future cognitive rehabilitation protocols for counteracting spatial disorientation that may occur during elders’ traveling to unfamiliar locations. The research protocol has been approved by the Ethics Committee of the Istituto Auxologico Italiano. Findings will be published in peer-reviewed medical journals and discussed in national and international congresses.

BACKGROUND AND PURPOSE:Post-stroke dysphagia affects outcome. In acute stroke patients, the aim was to evaluate clinical, cognitive and neuroimaging features associated with dysphagia and develop a predictive score for dysphagia.METHODS:Ischaemic stroke patients underwent clinical, cognitive and pre-morbid function evaluations. Dysphagia was retrospectively scored on admission and discharge with the Functional Oral Intake Scale.RESULTS:In all, 228 patients (mean age 75.8 years; 52% males) were included. On admission, 126 (55%) were dysphagic (Functional Oral Intake Scale ≤6). Age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00-1.05), pre-event modified Rankin scale (mRS) score (OR 1.41, 95% CI 1.09-1.84), National Institutes of Health Stroke Scale (NIHSS) score (OR 1.79, 95% CI 1.49-2.14), frontal operculum lesion (OR 8.53, 95% CI 3.82-19.06) and Oxfordshire total anterior circulation infarct (TACI) (OR 1.47, 95% CI 1.05-2.04) were independently associated with dysphagia at admission. Education (OR 0.91, 95% CI 0.85-0.98) had a protective role. At discharge, 82 patients (36%) were dysphagic. Pre-event mRS (OR 1.28, 95% CI 1.04-1.56), admission NIHSS (OR 1.88, 95% CI 1.56-2.26), frontal operculum involvement (OR 15.53, 95% CI 7.44-32.43) and Oxfordshire classification TACI (OR 3.82, 95% CI 1.95-7.50) were independently associated with dysphagia at discharge. Education (OR 0.89, 95% CI 0.83-0.96) and thrombolysis (OR 0.77, 95% CI 0.23-0.95) had a protective role. The 6-point "NOTTEM" (NIHSS, opercular lesion, TACI, thrombolysis, education, mRS) score predicted dysphagia at discharge with good accuracy. Cognitive scores had no role in dysphagia risk.CONCLUSIONS:Dysphagia predictors were defined and a score was developed to evaluate dysphagia risk during stroke unit stay. In this setting, cognitive impairment is not a predictor of dysphagia. Early dysphagia assessment may help in planning future rehabilitative and nutrition strategies.

Objective:Dementia among migrants is an emerging phenomenon worldwide and the development of neuropsychological tests sensitive to cultural differences is increasingly regarded as a priority. The Clock Drawing Test (CDT) is one of the most used screening tools for the detection of cognitive decline. Nevertheless, there is still a debate about its adoption as a cross-cultural assessment. Methods:To identify cultural variables influencing performance at CDT, we performed a systematic review of literature on three databases of all studies considering the role of at least one of the following: (1) language; (2) education; (3) literacy; (4) acculturation; and (5) ethnicity. Results:We extrapolated 160 analyses from 105 studies. Overall, an influence of cultural determinants on performance at CDT was found in 127 analyses (79.4%). Regarding specific cultural factors, 22 analyses investigated the effect of ethnicity on CDT scores, reporting conflicting results. Only two scoring systems turned out to be sufficiently accurate in a multicultural population. Language influenced performance in only 1 out of 8 analyses. A higher level of education positively influenced test performance in 118 out of 154 analyses (76.6%), and a better quality of education in 1 analysis out of 2. A negative influence of illiteracy on CDT performance emerged in 9 out of 10 analyses. Acculturation affected performances at CDT in 1 out of 2 studies. Conclusions:Based on the present findings, caution is needed when using CDT in a multicultural context, even if it requires limited linguistic competence.