Funzioni cognitive e controllo glicemico: evidenze dallo studio di pazienti pediatrici con diabete mellito tipo 1 e bambini prematuri

Premessa: Le funzioni esecutive sono funzioni cognitive di ordine superiore che includono le capacità di inibizione, memoria di lavoro e flessibilità cognitiva e rivestono un ruolo essenziale per la salute psicofisica dell’individuo. Lo sviluppo di queste funzioni è legato alla maturazione delle strutture corticali e sottocorticali che ne costituiscono substrato neurale. Il cervello attraversa nel corso dell’ età - gestazionale prima ed evolutiva poi - il massimo della propria maturazione. Problemi di natura metabolica, come una mancata regolazione dell’omeostasi glucidica e livelli anormalmente alti di glucosio nel sangue, costituiscono fattori di rischio per il neurosviluppo. Due popolazioni cliniche in particolare sono esposte ad esiti sfavorevoli in termini di funzionamento cognitivo e neurosviluppo a causa di episodi di ipoglicemie e iperglicemie: il neonato prematuro e il paziente con diabete mellito tipo 1 in età pediatrica. L’uso delle recenti tecnologie di monitoraggio della glicemia in continuo (CGM) permette l’individuazione precoce di episodi di ipoglicemia e iperglicemia e si è dimostrato promettente al fine di migliorare l’andamento glicemico. Se molto è stato visto e dimostrato per quanto riguarda gli esiti in termini di controllo glicometabolico, controversi sono gli esiti in termini di outcome di qualità di vita e modeste sono le evidenze circa gli outcome sul neurosviluppo e adattamento psicosociale dell’uso dei CGM. Sono stati pertanto condotti due studi su queste popolazioni cliniche. Obiettivo: indagare la validità dell’utilizzo precoce dei sistemi di monitoraggio della glicemia in continuo CGM al fine di prevenire poveri outcome in termini di neurosviluppo e di funzioni esecutive nelle due popolazioni cliniche: bambini nati prematuri e bambini/ragazzi con Diabete Mellito Tipo 1. Risultati: Per quanto concerne la popolazione di neonati prematuri i risultati evidenziano outcome migliori in termini di comunicazione recettiva ed espressiva nei bambini con più bassa variabilità glicemica nelle prime due settimane di vita (p=0.016). Inoltre, una funzionalità migliore del sistema attentivo nei bambini con più alta percentuale di Time in Range (TIR) nelle prime settimane dopo la nascita (p=0.011). Per quanto concerne la popolazione di bambini e ragazzi con DM1, i dati del presente studio mostrano che pazienti preadolescenti e adolescenti con sistemi di monitoraggio della glicemia integrati con pompe di insulina a sistema ibrido chiuso mostrano una migliore flessibilità cognitiva e velocità di elaborazione (p=0.006) rispetto ai pari in terapia multiniettiva, parimenti evidenziano livelli più elevati di TIR, più bassi di TAR e una più elevata Qualità di Vita. Conclusioni: I risultati suggeriscono che un utilizzo precoce di sistemi di monitoraggio glicemico possano essere utili al fine di proteggere le funzioni esecutive e il neurosviluppo. Lo studio suggerisce la necessità di svolgere screening neuropsicologici e psicologici frequenti nelle due popolazioni analizzate al fine di intercettare precocemente eventuali problematiche a carico del sistema neuro-cognitivo ed affettivo e permettere un precoce intervento agendo positivamente nella traiettoria di sviluppo.Background: Executive functions are higher-level cognitive skills, including inhibition, working memory and cognitive flexibility. They play an essential role in the psychophysical health of the individual. The development of these functions is linked to the maturation of the cortical and subcortical structures, that constitute their neural substrate. During the gestational age and developmental age, the brain reaches the maximum of its maturation. Metabolic problems, such as impaired regulation of glucose homeostasis and abnormally high blood glucose levels, represent risk factors for neurodevelopment. Two particular clinical populations are exposed to adverse outcomes in terms of cognitive functioning and neurodevelopment, due to episodes of hypoglycemia and hyperglycemia: preterm infants and youths with type 1 diabetes. The use of recent continuous glucose monitoring (CGM) technologies allows early detection of hypoglycemia and hyperglycemia episodes and has shown promising results improving glycemic control. The outcomes in terms of glycometabolic control appear to be clarified and demonstrated. On the contrary, the outcomes in terms of quality of life are still controversial as well as the evidence regarding the outcomes on neurodevelopment and psychosocial adaptation of the use of CGMs. Therefore, two studies were conducted in these clinical populations. Aim: investigate the validity of the early use of CGM, in order to prevent poor outcomes in terms of both neurodevelopment and executive functions development, in the two clinical populations: preterm infants and youths with type 1 diabetes. Results: regarding preterm infants population, the results show better outcomes in terms of receptive and expressive communication in children with lower glycemic variability during the first two weeks of life (p=0.016). Furthermore, a better function of the attentional system in children with higher percentage of Time in Range (TIR) during the two weeks after the birth (p=0.011). Concerning the population of children with type 1 diabetes, data from the present study show that preadolescent and adolescent patients with glucose monitoring systems integrated with hybrid closed-loop pump show improved cognitive flexibility and processing speed (p= 0.006), compared to peers in multi daily injection therapy. In the same time, they show higher levels of TIR, lower TAR, and a higher quality of life. Conclusions: The results suggest that early use of continuous glucose monitoring systems may positively affect executive functions and neurodevelopment. Moreover, the study suggests the need to perform frequent neuropsychological and psychological screenings in the two populations analyzed, in order to early detect possible neuro-cognitive and affective problems, and to allow early intervention, with positive effects on the development trajectory

Abnormal default system functioning in depression: Implications for emotion regulation

open5noDepression is widely seen as the result of difficulties in regulating emotions. Based on neuroimaging studies on voluntary emotion regulation, neurobiological models have focused on the concept of cognitive control, considering emotion regulation as a shift toward involving controlled processes associated with activation of the prefrontal and parietal executive areas, instead of responding automatically to emotional stimuli. According to such models, the weaker executive area activation observed in depressed patients is attributable to a lack of cognitive control over negative emotions. Going beyond the concept of cognitive control, psychodynamic models describe the development of individuals’ capacity to regulate their emotional states in mother-infant interactions during childhood, through the construction of the representation of the self, others, and relationships. In this mini-review, we link these psychodynamic models with recent findings regarding the abnormal functioning of the default system in depression. Consistently with psychodynamic models, psychological functions associated with the default system include self-related processing, semantic processes, and implicit forms of emotion regulation. The abnormal activation of the default system observed in depression may explain the dysfunctional aspects of emotion regulation typical of the condition, such as an exaggerated negative self-focus and rumination on self-esteem issues. We also discuss the clinical implications of these findings with reference to the therapeutic relationship as a key tool for revisiting impaired or distorted representations of the self and relational objects.openMessina, Irene; Francesca, Bianco; Cusinato, Maria; Calvo, Vincenzo; Sambin, MarcoMessina, Irene; Bianco, Francesca; Cusinato, Maria; Calvo, Vincenzo; Sambin, Marc

Anxiety, depression, and glycemic control during Covid-19 pandemic in youths with type 1 diabetes.

Abstract Objectives Our study aims to assess the impact of lockdown during the coronavirus disease 2019 pandemic on glycemic control and psychological well-being in youths with type 1 diabetes. Methods We compared glycemic metrics during lockdown with the same period of 2019. The psychological impact was evaluated with the Test of Anxiety and Depression. Results We analyzed metrics of 117 adolescents (87% on Multiple Daily Injections and 100% were flash glucose monitoring/continuous glucose monitoring users). During the lockdown, we observed an increase of the percentage of time in range (TIR) (p<0.001), with a significant reduction of time in moderate (p=0.002), and severe hypoglycemia (p=0.001), as well as the percentage of time in hyperglycemia (p<0.001). Glucose variability did not differ (p=0.863). The glucose management indicator was lower (p=0.001). 7% of youths reached the threshold-score (≥115) for anxiety and 16% for depression. A higher score was associated with lower TIR [p=0.028, p=0.012]. Conclusions Glycemic control improved during the first lockdown period with respect to the previous year. Symptoms of depression and anxiety were associated with worse glycemic control; future researches are necessary to establish if this improvement is transient and if psychological difficulties will increase during the prolonged pandemic situation

Human cases of West Nile Virus infection in north-eastern Italy, 15 June to 15 November 2010.

In 2010, for the third consecutive year, human cases of West Nile virus (WNV) infection, including three confirmed cases of neuroinvasive disease and three confirmed cases of West Nile fever, were identified in north-eastern Italy. While in 2008 and 2009 all human cases of WNV disease were recorded in the south of the Veneto region, cases of WNV disease in 2010 additionally occurred in two relatively small northern areas of Veneto, located outside those with WNV circulation in the previous years. WNV IgG antibody prevalence in blood donors resident in Veneto was estimated as ranging from 3.2 per 1,000 in areas not affected by cases of WNV disease to 33.3 per 1,000 in a highly affected area of the Rovigo province. No further autochthonous human cases of WNV disease were notified in Italy in 2010. The recurrence of human cases of WNV infection for the third consecutive year strongly suggests WNV has become endemic in north-eastern Italy