Psychiatric, behavioral, and cognitive disorders in patients with extracranial cancers

Patients with cancer may report neuropsychiatric abnormalities including cognitive impairment, behavioral disturbances, and psychiatric disorders that potentially worsen their quality of life, reduce their treatment response, and aggravate their overall prognosis. Neuropsychiatric disturbances have a different pathophysiology, including immuno-inflammatory and neuroendocrine mechanisms, as a consequence of oncologic treatments (chemo- and radio-therapy). Among clinicians involved in the management of such patients, psychiatrists need to pay particular attention in recognizing behavioral disturbances that arise in oncologic patients, and determining those that may be effectively treated with psychotropic medications, psychotherapeutic interventions, and an integration of them. Through the contribution of different clinicians actively involved in the management of oncological patients, the present review is ultimately aimed at updating psychiatrists in relation to the pathophysiological mechanisms responsible for the onset of cognitive, affective, and behavioral syndromes in these patients, along with epidemiologic and clinical considerations and therapeutic perspectives

The validation service of the hydrological SAF geostationary and polar satellite precipitation products

Abstract. The development phase (DP) of the EUMETSAT Satellite Application Facility for Support to Operational Hydrology and Water Management (H-SAF) led to the design and implementation of several precipitation products, after 5 yr (2005–2010) of activity. Presently, five precipitation estimation algorithms based on data from passive microwave and infrared sensors, on board geostationary and sun-synchronous platforms, function in operational mode at the H-SAF hosting institute to provide near real-time precipitation products at different spatial and temporal resolutions. In order to evaluate the precipitation product accuracy, a validation activity has been established since the beginning of the project. A Precipitation Product Validation Group (PPVG) works in parallel with the development of the estimation algorithms with two aims: to provide the algorithm developers with indications to refine algorithms and products, and to evaluate the error structure to be associated with the operational products. In this paper, the framework of the PPVG is presented: (a) the characteristics of the ground reference data available to H-SAF (i.e. radar and rain gauge networks), (b) the agreed upon validation strategy settled among the eight European countries participating in the PPVG, and (c) the steps of the validation procedures. The quality of the reference data is discussed, and the efforts for its improvement are outlined, with special emphasis on the definition of a ground radar quality map and on the implementation of a suitable rain gauge interpolation algorithm. The work done during the H-SAF development phase has led the PPVG to converge into a common validation procedure among the members, taking advantage of the experience acquired by each one of them in the validation of H-SAF products. The methodology is presented here, indicating the main steps of the validation procedure (ground data quality control, spatial interpolation, up-scaling of radar data vs. satellite grid, statistical score evaluation, case study analysis). Finally, an overview of the results is presented, focusing on the monthly statistical indicators, referred to the satellite product performances over different seasons and areas

The interpretation of a complex picture and its sensitivity to frontal damage : A reappraisal

A.R. Luria introduced the interpretation of a meaningful picture as a tool for assessing pre-frontal impairment. We gave this test to 196 normal adults, who were asked to communicate what was happening in the portrayed scene (a boy chases a mouse hidden under a cupboard, while three frightened girls assist). The same subjects were given two other frontal tests (verbal fluency on phonemic cue and Trail Making Test (TMT)) and Raven's Matrices. Twenty-three normal subjects (12%) failed to correctly interpret the picture. We also examined 20 patients whose brain lesion encroached upon pre-frontal areas, in order to check if this version of the test could be easily administered to this type of patient, and if its difficulty level was appropriate for avoiding ceiling and floor effects. Twelve patients were unable to interpret the picture (60%). A similar failure rate was observed with the same subjects on verbal fluency and TMT, while Raven's Matrices were less impaired (35%). Some dissociation was found between Picture Interpretation and the TMT. The Italian version of the Picture Interpretation Test is suitable for the examination of pre-frontal patients

Mirror asymmetry of category and letter fluency in traumatic brain injury and Alzheimer's patients

In this study we contrasted the Category fluency and Letter fluency performance of 198 normal subjects, 57 Alzheimer's patients and 57 patients affected by traumatic brain injury (TBI). The aim was to check whether, besides the prevalence of Category fluency deficit often reported among Alzheimer's patients, the TBI group presented the opposite dissociation. According to some recent claims, in fact, the deficit of TBI would be equally severe for both fluency types. The inquiry followed different approaches for data analysis, including the evaluation of a unique index (Fluency Type Index or FTI), independent of the overall fluency and aimed at expressing at individual subject level the relationship between Category and Letter fluency. The results confirmed that Alzheimer's patients are more defective on Category than Letter fluency, and also clearly indicated that an opposite pattern applies to TBI patients. TBI seems to cause a relatively more severe impairment of Letter than Category fluency, probably due to its impact on the frontal lobe structures. We discuss whether, on the basis of the statistical distribution of our data, it is worth considering as homogeneous populations broadly defined groups as Alzheimer's or TBI patients

Apraxia is not associated to a disproportionate naming impairment for manipulable objects

The relevance of gesture knowledge for the semantic representation of manipulable objects was investigated in a series of 15 patients with a focal left-hemisphere lesion. The patients were classified according to the presence/absence of ideomotor and ideational apraxia. We investigated picture naming and word-picture matching (pointing to a picture on verbal command) with stimuli including items from three categories: manipulable objects, non-manipulable objects, and animals. The analysis was performed at group level and at single-patient level. Nine patients were affected by ideational apraxia and nine by ideomotor apraxia: two cases presented ideomotor but not ideational apraxia, and two cases presented the opposite dissociation. Patients affected by ideational apraxia were more severely impaired in all tasks, but did not show a disproportionate impairment with the category of manipulable objects in contrast to the other categories. The presence of ideomotor apraxia did not cause a greater impairment in any task or category. Finally, we observed a patient with ideational apraxia who performed flawlessly in naming and word-picture matching for all the stimuli, including manipulable objects. In conclusion, we did not find a relationship between ideational apraxia and a disproportionate impairment of the semantic knowledge of manipulable objects