Travel Planning Ability in Right Brain-Damaged Patients: Two Case Reports

Planning ability is fundamental for goal-directed spatial navigation. Preliminary findings from patients and healthy individuals suggest that travel planning (TP)—namely, navigational planning—can be considered a distinct process from visuospatial planning (VP) ability. To shed light on this distinction, two right brain-damaged patients without hemineglect were compared with a control group on two tasks aimed at testing VP (i.e., Tower of London-16, ToL-16) and TP (i.e., Minefield Task, MFT). The former requires planning the moves to reach the right configuration of three colored beads on three pegs, whereas the latter was opportunely developed to assess TP in the navigational environment when obstacles are present. Specifically, the MFT requires participants to plan a route on a large carpet avoiding some hidden obstacles previously observed. Patient 1 showed lesions encompassing the temporoparietal region and the insula; she performed poorer than the control group on the ToL-16 but showed no deficit on the MFT. Conversely, Patient 2 showed lesions mainly located in the occipitoparietal network of spatial navigation; she performed worse than the control group on the MFT but not on the ToL-16. In both cases performances satisfied the criteria for a classical dissociation, meeting criteria for a double dissociation. These results support the idea that TP is a distinct ability and that it is dissociated from VP skills

Sex Differences in Spatial Memory: Comparison of Three Tasks Using the Same Virtual Context

Spatial memory has been studied through different instruments and tools with different modalities of administration. The cognitive load varies depending on the measure used and it should be taken into account to correctly interpret results. The aim of this research was to analyze how men and women perform three different spatial memory tasks with the same spatial context but with different cognitive demands. A total of 287 undergraduate students from the University of Almeria (Spain) and the University of L’Aquila (Italy) participated in the study. They were divided into three groups balanced by sex according to the spatial memory test they performed: the Walking Space Boxes Room Task (WSBRT), the Almeria Spatial Memory Recognition Test (ASMRT) and the Non-Walking Space Boxes Room Task (NWSBRT). Time spent and number of errors/correct answers were registered for analysis. In relation to the WSBRT and the ASMRT, men were faster and reached the optimal level of performance before women. In the three tests, familiarity with the spatial context helped to reduce the number of errors, regardless of the level of difficulty. In conclusion, sex differences were determined by the familiarity with the spatial context, the difficulty level of the task, the active or passive role of the participant and the amount of visual information provided in each screen shot

The Role of Gender and Familiarity in a Modified Version of the Almeria Boxes Room Spatial Task

ndividual factors like gender and familiarity can affect the kind of environmental representation that a person acquires during spatial navigation. Men seem to prefer relying on map-like survey representations, while women prefer using sequential route representations. Moreover, a good familiarity with the environment allows more complete environmental representations. This study was aimed at investigating gender differences in two different object-position learning tasks (i.e., Almeria Boxes Tasks) assuming a route or a survey perspective also considering the role of environmental familiarity. Two groups of participants had to learn the position of boxes placed in a virtual room. Participants had several trials, so that familiarity with the environment could increase. In both tasks, the effects of gender and familiarity were found, and only in the route perspective did an interaction effect emerge. This suggests that gender differences can be found regardless of the perspective taken, with men outperforming women in navigational tasks. However, in the route task, gender differences appeared only at the initial phase of learning, when the environment was unexplored, and disappeared when familiarity with the environment increased. This is consistent with studies showing that familiarity can mitigate gender differences in spatial tasks, especially in more complex ones

Rare but possible: clopidogrel-induced pancytopenia

We present the case of an 84-year-old female patient admitted to the Internal Medicine Ward for atypical chest pain and laboratory findings of severe pancytopenia. Past medical history was remarkable for an episode of myocardial infarction approximately 4 weeks prior to the current hospitalization which had required angioplasty + drug-eluting stent and dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. Some rare cases of clopidogrel-induced pancytopenia are described in scientific literature, therefore, after excluding infectious, vitamin deficiencies, and autoimmune causes, we modified the antiplatelet therapy by replacing clopidogrel with ticagrelor, obtaining complete leukocyte recovery within a few days. Since clopidogrel is an antiplatelet drug still used in clinical cardiological practice, the knowledge of this rare side effect may lead the clinician to suspect hematological toxicity which, if recognized promptly, may suggest modification of antiplatelet therapy and limit any possible infectious complications for the care of the patient

Continuous Environmental Changes May Enhance Topographic Memory Skills. Evidence From L’Aquila Earthquake-Exposed Survivors

Exposure to environmental contextual changes, such as those occurring after an earthquake, requires individuals to learn novel routes around their environment, landmarks and spatial layout. In this study, we aimed to uncover whether contextual changes that occurred after the 2009 L’Aquila earthquake affected topographic memory in exposed survivors. We hypothesized that individuals exposed to environmental changes—individuals living in L’Aquila before, during and after the earthquake (hereafter called exposed participants, EPs)—improved their topographic memory skills compared with non-exposed participants (NEPs) who moved to L’Aquila after the earthquake, as only EPs had to modify their previous cognitive map of L’Aquila. We also hypothesized that memory improvement was selective for the navigational space and did not generalize across other spatial and verbal domains. To test these hypotheses, we compared the topographic and spatial memory skills of 56 EPs without post-traumatic stress disorder (PTSD) symptoms to the skills of 47 NEPs using the Walking Corsi Test (WalCT; memory test in the navigational space) and the Corsi Block-Tapping Test (CBT; visuospatial memory test in the reaching space); EPs and NEPs were matched for gender, education and general navigational skills. A sub-group of participants also underwent the Rey-Auditory Verbal Learning Test (RAVLT; verbal memory test). The results showed that only EPs had better performances on topographic learning (TL) assessed using the WalCT rather than spatial learning assessed by the CBT. This outcome suggests the possibility that EPs specifically improved topographic memory. This effect may be due to continuous exposure to environmental changes that have required individuals to learn novel paths within the city and integrate novel information, such as “new towns,” into their pre-existing mental representation of the city. Implications and limitations of the study are discussed

Prolonged higher dose methylprednisolone vs. conventional dexamethasone in COVID-19 pneumonia: a randomised controlled trial (MEDEAS)

Dysregulated systemic inflammation is the primary driver of mortality in severe COVID-19 pneumonia. Current guidelines favor a 7-10-day course of any glucocorticoid equivalent to dexamethasone 6 mg·day-1. A comparative RCT with a higher dose and a longer duration of intervention was lacking

Does spatial locative comprehension predict landmark-based navigation?

In the present study we investigated the role of spatial locative comprehension in learning and retrieving pathways when landmarks were available and when they were absent in a sample of typically developing 6- to 11-year-old children. Our results show that the more proficient children are in understanding spatial locatives the more they are able to learn pathways, retrieve them after a delay and represent them on a map when landmarks are present in the environment. These findings suggest that spatial language is crucial when individuals rely on sequences of landmarks to drive their navigation towards a given goal but that it is not involved when navigational representations based on the geometrical shape of the environment or the coding of body movements are sufficient for memorizing and recalling short pathways

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes