Cognitive dysfunctions and psychological symptoms in migraine without aura: a cross-sectional study

BACKGROUND: The occurrence of cognitive dysfunctions and psychological symptoms, as well as their mutual relationships, in migraine patients are still debated. The aim of the study was to characterize the cognitive profile and psychological symptoms (i.e. depression, anxiety and apathy) in drug-naïve migraine without aura (MwoA) patients. METHODS: Seventy-two consecutive MwoA patients, referred to the Italian University Headache Clinic and 72 healthy subjects (HCs) were enrolled. Patients, during an attack-free period, and HCs completed Montreal Cognitive Assessment (MoCA), Beck Depression Inventory-II (BDI-II), Self-version of Apathy Evaluation Scale (AES-S) and State and Trait Anxiety Inventory (STAI-Y-1 and 2). Clinical parameters of disease severity (i.e. disease duration, migraine attacks per month, mean pain intensity during migraine attacks, migraine disability and impact on daily life) were recorded. RESULTS: Although performance of MwoA patients on MoCA was above Italian cut-off threshold (<15.5) suggesting presence of cognitive impairment, MwoA patients achieved significantly lower scores than HCs on total MoCA scale (22.3 ± 2.7 versus 25.4 ± 2.3) and on its attention (4.9 ± 1.1 versus 5.6 ± 0.7), memory (1.8 ± 1.4 versus 3.1 ± 1.3), visuospatial (3.2 ± 0.9 versus 3.6 ± 0.6) and executive subscales (2.6 ± 1.1 versus 3.1 ± 0.8). In addition, we observed significant correlations between MoCA executive domain subscore and the attack-related disability score (MIDAS). As for behavioral profile, the percentage of depressive symptoms (4.2 %), high state and trait anxiety (13.9 and 9.7 %, respectively), and apathy (11.1 %) in MwoA patients were similar to that of HCs. No significant associations of behavioural symptoms with cognitive performance and clinical parameters were found. CONCLUSIONS: Drug-naïve MwoA patients are characterized by subtle cognitive dysfunctions and low percentage of behavioural symptoms. The results support the importance of searching for subclinical cognitive disturbances in patients with MwoA, who deserve to be followed-up to verify whether they develop clinically relevant disorders over time

Determinants of early working impairments in multiple sclerosis

IntroductionUnemployment can directly affect social status and identity. Assessing and adjusting determinants of early working impairments in a chronic disease can thus reduce its long-term burden. Hereby, we aim to evaluate differences in occupational history and early working impairments between people with multiple sclerosis (MS) and healthy workers.MethodsThis is a cross-sectional study comparing 71 workers with MS [age 41.7 ± 9.4 years; females 59.1%; EDSS 2.0 (1.0–6.0)] and 71 controls (age 42.6 ± 11.9 years; females 33.8%). All participants filled in Work Ability Index (WAI), Work Productivity and Activity Impairment (WPAI), European Questionnaire for Quality of Life (EuroQoL), Beck Depression Inventory II (BDI-II), and Pittsburgh Sleep Quality Index (PSQI). In MS, we further collected expanded disability status scale (EDSS), MS Questionnaire for Job difficulties (MSQ-Job), Fatigue severity scale (FSS), and the Brief International Cognitive Assessment for MS (BICAMS).ResultsWorkers with MS were more working disabled (p < 0.01), less exposed to workplace risks (p < 0.01), and more limited in fitness to work (p = 0.01), compared with controls. On linear regression models adjusted by age, sex, education, and type of contract, people with MS had worse WAI (Coeff=−5.47; 95% CI = −7.41, −3.53; p < 0.01), EuroQoL (Coeff = −4.24; 95% CI = −17.85, −6.50; p < 0.01), BDI-II (Coeff = 3.99; 95% CI = 2.37, 7.01; p < 0.01), and PSQI (Coeff = 4.74; 95% CI = 3.13, 7.61; p < 0.01), compared with controls, but no differences in WPAI (p = 0.60). EuroQoL, BDI-II, and PSQI were equally associated with both WAI and WPAI in MS and controls (all p< 0.01). In MS, worse MSQJob was associated with higher EDSS (Coeff = 5.22; 95% CI = 2.24, 7.95; p < 0.01), progressive disease (Coeff = 14.62; 95% CI = 5.56, 23.69; p < 0.01), EuroQoL (Coeff = 4.63; 95% CI = 2.92, 6.35; p < 0.01), FSS (Coeff = 0.55; 95% CI = 0.38, 0.72; p < 0.01), and cognitive impairment (Coeff = 4.42; 95% CI = 0.67, 8.22; p = 0.02).DiscussionEarly factors associated with working difficulties in MS include disability, fatigue, depression, and cognitive dysfunction. Early identification of clinical features potentially causing working difficulties should be considered to enhance job retention, along with targeted prevention and protection measures

Search for 511 keV Emission in Satellite Galaxies of the Milky Way with INTEGRAL/SPI

Reproduced with permission from Astronomy & Astrophysics. © 2018 ESO.The positron annihilation gamma-ray signal in the Milky Way (MW) shows a puzzling morphology: a very bright bulge and a very low surface-brightness disk. A coherent explanation of the positron origin, propagation through the Galaxy and subsequent annihilation in the interstellar medium has not yet been found. Tentative explanations involve positrons from radioactivity, X-ray binaries, and dark matter (DM). Dwarf satellite galaxies (DSGs) are believed to be DM-dominated and hence promising candidates in the search for 511 keV emission as a result of DM annihilation into electron-positron pairs. The goal of this study is to constrain possible 511 keV gamma-ray signals from 39 DSGs of the MW and to test the annihilating DM scenario. We use the spectrometer SPI on INTEGRAL to extract individual spectra for the studied objects. As the diffuse galactic emission dominates the signal, the large scale morphology of the MW has been modelled accordingly and was included in a maximum likelihood analysis. Alternatively, a distance-weighted stacked spectrum has been determined. Only Reticulum II (Ret II) shows a 3.1 sigma signal. Five other sources show tentative 2 sigma signals. The mass-to-511-keV-luminosity-ratio shows a marginal trend towards higher values for intrinsically brighter objects, opposite to the V band mass-to-light-ratio, which is generally used to uncover DM in DSGs. All derived flux values are above the level implied by a DM interpretation of the MW bulge signal. The signal from Ret II is unlikely to be related to a DM origin alone, otherwise, the MW bulge would be about 100 times brighter than what is seen. Ret II is exceptional considering the DSG sample, and rather points to enhanced recent star formation activity, if its origins are similar to processes in the MW. Understanding this emission may provide further clues regarding the origin of the annihilation emission in the MW.Peer reviewe

Funzioni cognitive e capacità olfattive: correlazione e confronto nella SM recidivante remittente e nella SM secondariamente progressiva

Il presente studio nasce dall’esigenza di fare chiarezza rispetto ai risultati contrastanti ottenuti fino ad oggi sui disturbi olfattivi nella Sclerosi Multipla. Come illustrato nel precedente capitolo la maggior parte degli studi che hanno analizzato i disturbi olfattivi nella SM hanno riscontrato che i soggetti che mostravano disturbi olfattivi più marcati sviluppavano forme di SM più aggressive (Lucassen et al., 2016). Recentemente uno studio ha riportato dei risultati relativi al confronto delle capacità olfattive in pazienti con SM Primaria Progressiva e Recidivante Remittente (Schmidt et al., 2017). Lo studio in questione è stato condotto su 32 pazienti con SM-RR, 32 pazienti con SM-PP e 32 soggetti sani, le capacità olfattive sono state valutate somministrando il test per soglia (threshold T), discriminazione (D), identificazione (I) a ciascun soggetto. I risultati hanno rilevato deficit olfattivi in ventisette pazienti con SM-PP, in dieci pazienti con SM-RR e solo in uno dei soggetti sani. I risultati hanno mostrato inoltre una differenza significativa tra le capacità olfattive dei soggetti sani e quelli dei pazienti con SM-PP e tra quelle di quest’ultimo gruppo e dei pazienti con SM-RR (figura 7). È stata inoltre riscontrata una correlazione significativa tra i punteggi ottenuti al test dell’olfatto ed età, genere ed EDSS (indice della gravità clinica della malattia). Sulla base di questi risultati si è giunti alla conclusione che i disturbi olfattivi sono più frequenti e gravi nei pazienti con SM-PP, e sono strettamente dipendenti dalla durata della malattia e dal grado di disabilità totale. Il nostro studio ad oggi è l’unico studio che ha messo a confronto le capacità olfattive nelle diverse forme di SM. Partendo da queste evidenze scientifiche e dalla presenza di risultati ancora incerti ed incoerenti sull’argomento è nata l’esigenza di condurre questo nuovo studio, che confronta per la prima volta le capacità olfattive dei pazienti con diagnosi di SM-RR e SM-SP, per alimentare la presenza di dati sulle capacità olfattive nelle diverse forme di SM e aiutare ad avvalorare l’ipotesi secondo cui i disturbi delle capacità olfattive sono correlati a forme più gravi di SM, nell’ottica della prevenzione e del miglioramento della qualità di vita del paziente

Normative values of the Rao’s Brief Repeatable Battery in an Italian young adolescent population: the influence of age, gender, and education

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Neuropsychological correlates of Pisa syndrome in patients with Parkinson's disease

Background: A complex relationship exists between postural control and cognition in the elderly. Namely, neural mechanisms that are required for the regulation of posture have been variably associated with cognitive dysfunctions. Parkinson's disease (PD) is the second most common neurodegenerative disease among the elderly, and it has been associated with both cognitive and postural abnormalities such as Pisa syndrome (PS). Although its onset has been considered to be multifactorial, the pathophysiological mechanisms underpinning PS are still not fully explained. Until now, no study investigated the possible contribution of cognitive dysfunction to occurrence of PS in PD. Patients and methods: Twenty PD patients with PS and 20 PD patients without PS were enrolled. All patients with PD underwent neuropsychological battery to assess behavioural disturbances, memory, attention, frontal/executive and visuospatial functions. Results: The two groups did not differ on demographic features, age at PD onset and disease duration, whereas they significantly differed on UPDRS-Part III, and levodopa-equivalent daily dose (LEDD). MANCOVA with above-mentioned clinical variable as covariates revealed significant differences on tasks tapping verbal long-term memory, and attentional and visuoperceptual abilities between groups. The binary logistic regression revealed that higher LEDD and lower performance on visuospatial task (Benton Judgment of Lines Orientation test) significantly predicted occurrence of PS. Conclusion: Our results revealed a significant association of PS with altered attention and visuoperceptual functions in PD, suggesting that the occurrence of PS may be associated with alteration of both frontal–striatal systems and posterior cortical areas

Anxiety in early Parkinson's disease: Validation of the Italian observer-rated version of the Parkinson Anxiety Scale (OR-PAS)

Introduction Anxiety disorders are common in Parkinson's Disease (PD) and their identification is relevant even at early stages. The Parkinson Anxiety Scale (PAS) evaluates anxiety in PD; it was used only in the original validation study in PD patients mainly at 2-3 stages of Hoehn & Yahr system (H&Y). The study aimed to investigate psychometric properties of observer-rated version of the PAS (OR-PAS), prevalence rate of anxiety and its features, compared with diagnostic criteria in early PD patients. Methods A sample of 101 PD patients with H&Y:1-2 underwent the OR-PAS. To assess convergent and divergent validity, PD patients underwent Beck Anxiety Inventory, and scales assessing depression, apathy, anhedonia and cognition. To diagnose anxiety disorders, Mini International Neuropsychiatric Inventory was used as gold standard. A "receiver operating characteristics" curve was obtained; positive and negative predictive values were calculated for different cut-off points of the OR-PAS and its subscales. Results There was no missing data, no floor and ceiling effects; mean score was 12.2 ± 10.1; Cronbach's alpha was 0.899. The OR-PAS showed good convergent and divergent validity. Maximum discrimination was obtained with a cut-off score of 8.5. The anxiety occurred in 59 patients (58.4%). Conclusion The OR-PAS is a reliable and valid screening instrument for assessing anxiety in patients at early PD. Anxiety was found in 58.4% of PD patients, demonstrating that anxiety occurs even at early stages

Normative data for the Montreal Cognitive Assessment in an Italian population sample

The Montreal Cognitive Assessment (MoCA) is a rapid screening battery, also including subtests to assess frontal functions such as set-shifting, abstraction and cognitive flexibility. MoCA seems to be useful to identify non-amnestic mild cognitive impairment (MCI) and subcortical dementia; it has high sensitivity and specificity in distinguishing MCI from mild Alzheimer's Disease. Previous studies revealed that certain items of MoCA may be culturally biased and highlighted the need for population-based norms for the MoCA. The aim of present study was to collect normative values in a sample of Italian healthy subjects. Four hundred and fifteen Italian healthy subjects (252 women and 163 men) of different ages (age range 21-95 years) and educational level (from primary to university) underwent MoCA and Mini Mental State Examination (MMSE). Multiple linear regression analysis revealed that age and education significantly influenced performance on MoCA. No significant effect of gender was found. From the derived linear equation, a correction grid for MoCA raw scores was built. Inferential cut-off score, estimated using a non-parametric technique, is 15.5 and equivalent scores were computed. Correlation analysis showed a significant but weak correlation between MoCA adjusted scores with MMSE adjusted scores (r = 0.43, p < 0.001). The present study provided normative data for the MoCA in an Italian population useful for both clinical and research purposes