Visuospatial abilities in normal and pathological aging: cognitive processes and neuroimaging correlates

The field of spatial cognition has been evolving rapidly over the last few years, driven by convergence of results from both basic and clinical research. Spatial ability is involved in many cognitive tasks typically performed in everyday life, so it is important to accurately define and assess spatial ability in the context of everyday life. Recent studies also suggest that spatial abilities decline with normal aging, but it is not yet clear which spatial components decline during normal age-related cognitive decline, which are preserved, and at what point the spatial deficits become severe enough to suggest MCI or another degenerative disease. The main goal of my research projects, developed in three studies, was to investigate different components of spatial ability in a population of healthy older people, in individuals affected by mild cognitive impairment, and in autopsy-verified patients with dementia, in order to (a) develop new, more ecological instruments for the assessment of spatial abilities, (b) verify whether the assessment of spatial abilities may help in discriminating between MCI and controls and be used as a marker of the onset of AD, and (c) be used in differential diagnosis between Alzheimer's Disease and Dementia with Lewy bodies. In Study 1, results confirm the a priori hypothesis, ascertaining the reliability of these new spatial tests in measuring different components of spatial abilities: object memory, simultaneous spatial memory and sequential spatial memory. In the second study, the discriminant analyses revealed an elevated discriminative power of the new spatial battery in identifying MCI. Neuroimaging findings showed that MCI patients present a higher level of cortical atrophy in memory-related regions and a different pattern of brain correlation between visuospatial abilities and grey matter values compared with healthy elderly controls. Finally, results of Study 3 suggest that disproportionately severe visuospatial deficits, which are known to be prevalent in DLB patients, also extend to visuoperceptual abilities that do not involve construction or motor manipulation. This deficit reflects primarily Lewy Body pathology and is not related to the degree of concomitant AD pathology. All of this evidence supports the main idea that visuospatial evaluation should have a greater role in normal and pathological aging, in understanding the daily life abilities of healthy older people, in completing the diagnostic process of MCI, and also helping in the differential diagnosis between different types of dementia

The role of limbic structures in financial abilities of mild cognitive impairment patients

Mild Cognitive Impairment (MCI) patients experience problems in financial abilities that affect everyday functioning. To date, the neural correlates of decline in this domain are unclear. This study aims at examining the correlation between the pattern of brain atrophy of MCI patients and performance on financial abilities. Forty-four MCI patients and thirty-seven healthy controls underwent structural magnetic resonance imaging, and assessment of financial abilitiesby means of the Numerical Activities of Daily Living Financial battery (NADL-F). As compared to healthy controls, MCI patients showed impaired performance in three out of the seven domains assessed by NADL-F: Item purchase, percentage, and financial concepts. The patients\u2019 performance in the NADL-F correlated with memory, language, visuo-spatial, and abstract reasoning composite scores. The analysis also revealed that volumetric differences in the limbic structures significantly correlated with financial abilities in MCI. Specifically, the patients\u2019 performance in the NADL-F was correlated with atrophy in the left medial and lateral amygdala and the right anterior thalamic radiation. These findings suggest that completing daily financial tasks involves sub-cortical regions in MCI and presumably also the motivational and emotional processes associated to them. Involvement of altered limbic structures in MCI patients suggests that impairment in financial abilities may be related to emotional and reflexive processing deficits

Multiple brain networks support processing speed abilities of patients with multiple sclerosis

Objectives: Many people affected by multiple sclerosis (MS) experience cognitive impairment, especially decreases in information processing speed (PS). Neural disconnection is thought to represent the neural marker of this symptom, although the role played by alterations of specific functional brain networks still remains unclear. The aim is to investigate and compare patterns of association between PS-demanding cognitive performance and functional connectivity across two MS phenotypes. Methods: Forty patients with relapsing-remitting MS (RRMS) and 25 with secondary progressive MS (SPMS) had neuropsychological and MRI assessments. Multiple regression models were used to investigate the relationship between performance on tests of visuomotor and verbal PS, and on the verbal fluency tests, and functional connectivity of four cognitive networks, i.e. left and right frontoparietal, salience and default-mode, and two control networks, i.e. visual and sensorimotor. Results: Patients with SPMS were older and had longer disease history than patients with RRMS and presented with worse overall clinical conditions: higher disease severity, total lesion volume, and cognitive impairment rates. However, in both patient samples, cognitive performance across tests was negatively correlated with functional connectivity of the salience and default-mode networks, and positively with connectivity of the left frontoparietal network. Only the visuomotor PS scores of the RRMS group were also associated with connectivity of the sensorimotor network. Conclusions: PS-demanding cognitive performance in patients with MS appears mainly associated with strength of functional connectivity of frontal networks involved in the evaluation and manipulation of information, as well as the default mode network. These results are in line with the hypothesis that multiple neural networks are needed to support normal cognitive performance across MS phenotypes. However, different PS measures showed partially different patterns of association with functional connectivity. Therefore, further investigations are needed to clarify the contribution of inter-network communication to specific cognitive deficits due to MS

Cognitive rehabilitation in multiple sclerosis: A systematic review

Abstract Background Cognitive impairment is a common clinical feature of multiple sclerosis (MS) at both the earlier and later stages of the disease, and has a significant impact on patients' functional status and quality of life. The need to address this deficit should be taken into account in clinical practice and research studies. Objective To conduct an updated systematic review of all published studies of cognitive rehabilitation interventions in people with MS, including studies with methodological shortcomings, to highlight major strengths and weaknesses in the field and to provide directions for future research. Search methods We searched electronic databases (PubMed and Web of Science) for articles published in English up until January 2014. The reference lists of all identified articles were also searched to complete the initial list of references. Data extraction Articles were categorized into outcome measures: cognition, imaging, mood, fatigue, quality of life and self-perceived cognitive deficits. All articles were reviewed independently and assessed according to predetermined criteria. Results A total of 33 studies met the inclusion criteria of which 4 were of Level II-1 and none was Level I. Although the majority of these studies reported some improvements in cognitive abilities (N = 31), the evidence which has been reported in the literature remains inconclusive and no definite conclusions can be drawn about the effect of different types of interventions on cognitive rehabilitation outcomes (recommendation C). Conclusions This review identified conflicting findings in the published literature about the effectiveness of various forms of cognitive rehabilitation techniques used in patients with MS. Studies with more rigorous methodology are therefore needed to clarify which form of cognitive rehabilitation may lead to greater clinical improvement

Relationship between spatial ability, visuospatial working memory and self-assessed spatial orientation ability: a study in older adults

This paper describes some novel spatial tasks and questionnaires designed to assess spatial and orientation abilities. The new tasks and questionnaires were administered to a sample of 90 older adults (41 males, age range 57–90), along with some other tests of spatial ability (Minnesota Paper Form Board, Mental Rotations Test, and Embedded Figures Test) and tests of visuospatial working memory (Corsi’s Block Test and Visual Pattern Test). The internal reliability of the new tasks and questionnaires was analyzed, as well as their relationship with the spatial and working memory tests. The results showed that the new spatial tasks are reliable, correlate with working memory and spatial ability tests and, compared with the latters, show stronger correlations with the self-report questionnaires referring to orientation abilities. A model was also tested (with reference to Allen et al. in Intelligence 22:327–355, 1996) in which the new tasks were assumed to relate to spatial ability and predict orientation abilities as assessed by the self-report measures

Visuospatial abilities in normal and pathological aging: cognitive processes and neuroimaging correlates

The field of spatial cognition has been evolving rapidly over the last few years, driven by convergence of results from both basic and clinical research. Spatial ability is involved in many cognitive tasks typically performed in everyday life, so it is important to accurately define and assess spatial ability in the context of everyday life. Recent studies also suggest that spatial abilities decline with normal aging, but it is not yet clear which spatial components decline during normal age-related cognitive decline, which are preserved, and at what point the spatial deficits become severe enough to suggest MCI or another degenerative disease. The main goal of my research projects, developed in three studies, was to investigate different components of spatial ability in a population of healthy older people, in individuals affected by mild cognitive impairment, and in autopsy-verified patients with dementia, in order to (a) develop new, more ecological instruments for the assessment of spatial abilities, (b) verify whether the assessment of spatial abilities may help in discriminating between MCI and controls and be used as a marker of the onset of AD, and (c) be used in differential diagnosis between Alzheimer's Disease and Dementia with Lewy bodies. In Study 1, results confirm the a priori hypothesis, ascertaining the reliability of these new spatial tests in measuring different components of spatial abilities: object memory, simultaneous spatial memory and sequential spatial memory. In the second study, the discriminant analyses revealed an elevated discriminative power of the new spatial battery in identifying MCI. Neuroimaging findings showed that MCI patients present a higher level of cortical atrophy in memory-related regions and a different pattern of brain correlation between visuospatial abilities and grey matter values compared with healthy elderly controls. Finally, results of Study 3 suggest that disproportionately severe visuospatial deficits, which are known to be prevalent in DLB patients, also extend to visuoperceptual abilities that do not involve construction or motor manipulation. This deficit reflects primarily Lewy Body pathology and is not related to the degree of concomitant AD pathology. All of this evidence supports the main idea that visuospatial evaluation should have a greater role in normal and pathological aging, in understanding the daily life abilities of healthy older people, in completing the diagnostic process of MCI, and also helping in the differential diagnosis between different types of dementia.Le abilità spaziali sono coinvolte in molte attività della vita quotidiana, pertanto risulta importante valutarle e comprendere le sue ripercussioni nella vita di tutti i giorni. Recenti studi suggeriscono che le abilità spaziali peggiorano nell'invecchiamento normale, ma non è chiaro quali specifiche componenti declinano all'aumentare dell'età, quali sono preservate e quando il deficit spaziale diventa così severo da suggerire la presenza di un disturbo cognitivo lieve o di patologia degenerativa. L'obiettivo principale della mia tesi di dottorato, sviluppata in tre diversi studi, è quello di esplorare lo sviluppo di deficit nelle abilità spaziali in una popolazione di anziani con invecchiamento normale, anziani con lieve compromissione cognitiva e pazienti con demenza degenerativa. Lo scopo della presente ricerca è dunque quello di a) sviluppare nuovi strumenti ecologici che ci consentano di valutare diverse componenti delle abilità spaziali, b) verificare se la valutazione delle abilità spaziali può aiutare nel discriminare tra compromissione cognitiva lieve e invecchiamento normale e se può essere considerata “marker” di demenza, c) valutare se le abilità spaziali possono giocare un ruolo e aiutare nella diagnosi differenziale tra Demenza di Alzheimer e Demenza a corpi di Lewy. I risultati dello Studio 1 confermano le ipotesi a priori, sottolineando l’efficacia di questi nuovi test spaziali nel misurare diverse componenti delle abilità spaziali: memoria di oggetti, memoria spaziale simultanea e memoria spaziale sequenziale. I risultati dello Studio 2 mostrano un elevato potere discriminativo delle nuove prove spaziali nel distinguere tra invecchiamento normale e compromissione cognitiva lieve. Inoltre, i dati di neuroimaging mostrano un diverso pattern di correlazioni tra deficit spaziali e materia grigia nei due gruppi. Infine, i risultati dello studio 3 mostrano deficit quantitativamente diversi tra il gruppo di pazienti con Demenza a corpi di Lewy e il gruppo di pazienti con Alzheimer in un test che valuta l'abilità visuopercettiva e che non richiede una manipolazione motoria. Si è dunque dimostrato che questo specifico deficit riflette un quadro di Demenza a corpi di Lewy ed è, invece, meno correlato con la patologia di Alzheimer. Tutte queste evidenze supportano l’idea che la valutazione delle abilità spaziali giochi un ruolo fondamentale nell’invecchiamento sia normale che patologico

How to enhance route learning and visuo-spatial working memory in aging: a training for residential care home residents

Objectives: This study aimed to assess the efficacy of a route-learning training in a group of older adults living in a residential care home. We verified the presence of training-specific effects in tasks similar to those trained route-learning tasks as well as transfer effects on related cognitive processes visuo-spatial short-term memory (VSSTM; Corsi Blocks Test (CBT), forward version), visuo- spatial working memory (VSWM; CBT, backward version; Pathway Span Tasks; Jigsaw Puzzle Test) and in self-report measures. The maintenance of training benefits was examined after 3 months. Method: Thirty 7090-year-old residential care home residents were randomly assigned to the route- learning training group or to an active control group (involved in non-visuo-spatial activities). Results: The trained group performed better than the control group in the route-learning tasks, retaining this benefit 3 months later. Immediate transfer effects were also seen in visuo-spatial span tasks (i.e., CBT forward and backward version and Pathway Span Task); these benefits had been substantially maintained at the 3-month follow-up. Conclusion: These findings suggest that a training on route learning is a promising approach to sustain older adults\u2019 environmental learning and some related abilities (e.g., VSSTM and VSWM), even in residential care home residents

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

none6no: Endoscopic endonasal surgery has gained a prominent role in the management of complex skull base tumors. It allows the resection of a large group of benign and malignant lesions through a natural anatomical extra-cranial pathway, represented by the nasal cavities, avoiding brain retraction and neurovascular manipulation. This is reflected by the patients' prompt clinical recovery and the low risk of permanent neurological sequelae, representing the main caveat of conventional skull base surgery. This surgery must be tailored to each specific case, considering its features and relationship with surrounding neural structures, mostly based on preoperative neuroimaging. Advanced MRI techniques, such as tractography, have been rarely adopted in skull base surgery due to technical issues: lengthy and complicated processes to generate reliable reconstructions for inclusion in the neuronavigation system. This paper aims to present the protocol implemented in the institution and highlights the synergistic collaboration and teamwork between neurosurgeons and the neuroimaging team (neurologists, neuroradiologists, neuropsychologists, physicists, and bioengineers) with the final goal of selecting the optimal treatment for each patient, improving the surgical results and pursuing the advancement of personalized medicine in this field.noneZoli, Matteo; Talozzi, Lia; Mitolo, Micaela; Lodi, Raffaele; Mazzatenta, Diego; Tonon, CaterinaZoli, Matteo; Talozzi, Lia; Mitolo, Micaela; Lodi, Raffaele; Mazzatenta, Diego; Tonon, Caterin