'Less is more': validation with Rasch analysis of five short-forms for the Brain Injury Rehabilitation Trust Personality Questionnaires (BIRT-PQs).

Background: Previous analyses demonstrated a lack of unidimensionality, item redundancy, and substantial administrative burden for the Brain Injury Rehabilitation Trust Personality Questionnaires (BIRT-PQs). Objective: To use Rasch Analysis to calibrate five short-forms of the BIRT-PQs, satisfying the Rasch model requirements. Methods: BIRT-PQs data from 154 patients with severe Acquired Brain Injury (s-ABI) and their caregivers (total sample = 308) underwent Rasch analysis to examine their internal construct validity and reliability according to the Rasch model. Results: The base Rasch analyses did not show sufficient internal construct validity according to the Rasch model for all five BIRT-PQs. After rescoring 18 items, and deleting 75 of 150 items, adequate internal construct validity was achieved for all five BIRT-PQs short forms (model chi-square p-values ranging from 0.0053 to 0.6675), with reliability values compatible with individual measurements. Conclusions: After extensive modifications, including a 48% reduction of the item load, we obtained five short forms of the BIRT-PQs satisfying the strict measurement requirements of the Rasch model. The ordinal-to-interval measurement conversion tables allow measuring on the same metric the perception of the neurobehavioral disability for both patients with s-ABI and their caregivers

Instruments for evalutation of altered states of consciousness

In recent years an increase of interest concerning the altered states of consciousness was observed. In particular literature provided a wide amount of contribution about the scales for measurement of level of responsivity. Our aim is to describe the principale scales used in diagnosis of Disorder of Consciousness (DOC) trying to illustrate administation procedures, specifically assessed aspects, modality of stimulation, reliability, and validity. We divided them in four main different groups: the first one in which descriptive scales are included, that is those scales basically used after a clinical observation; the second group which concerns scales requiring defined stimulation sets; in the third group we considered the scale which refer to diagnostic criteria stated by the Aspen Work Group (Giacino et al., 2002); whilst in the fourth group we describe a battery aimed to assess patients with severe cognitive deficits which are not yet evaluable with neuropsychological tests

The altered state of consciousness: clinical assessment and monitoring

Aim of this work is to provide an overview on the main clinical issues concerning disorder of consciousness (DOC). After a briefly description of the debate on clinical differences in states of altered consciousness, we report the description of clinical features of the three different levels of DOC: coma, vegetative state, and minimally conscious state, according to the Multi Society Task Force for Persistent Vegetative State (1994) and the Aspen Work Group (Giacino et al., 2002). We will then describe an observation procedure, stated by Whyte and coworkers in 1999, based upon a single-case methodology aimed to assess responsiveness and its variations. At least, we will give a description of the evidences on stimulation treatment efficacy, as we collected in occasion of the last Consensus Conference in Neuropsychological Rehabilitation held in Siena (Italy) in 2010. Our conclusions confirm the lack of evidences concerning the efficacy of treatment for recovery of consciousness in agreement with other authors and we will finally provide suggestions for future research

Integrazione di misure psicofisiologiche (EEG) e autonomiche (biofeedback) nello studio delle emozioni in pazienti disesecutivi

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Cognitive and electrophysiological empowerment in healthy aging: clinical and EEG evidences

It is widely accepted that physiological aging is a dynamic process and that cognitive and brain reserves act as protective factors against cognitive decline. The re-activation of networks mediating cognitive functions by cognitive and electrophysiological interventions may then lead to an improvement of functional profile. The research aims at investigating the efficacy of a prefrontal transcranial Direct Current Stimulation protocol (tDCS) and a computerized cognitive protocol (Cogn) in empowering cognitive functions and automatic attention responses in healthy elderly people. Thirty-two volunteers took part to the study and were divided into the tDCS, Cogn or control group. The experimental design included an initial assessment session (T0) and a 3-months re-test (T1), with standardized neuropsychological tests and Event-Related Potentials (ERPs) recording. Both intervention protocols lasted 8 weeks and included 3 sessions per week. Comparison of T0 and T1 data highlighted an increasing profile for specific post-intervention performances at neuropsychological tests in tDCS and Cogn groups. In addition, we also observed a modulation of ERPs responses to a challenging attention task. Finally, participants qualitatively reported subjective increases in everyday functioning. Our findings suggest that structured intervention protocols may help in empowering cognitive abilities in healthy aging people and hint at interesting implication for prevention and early intervention

Neuropsychology in the times of COVID-19. The role of the psychologist in taking charge of patients with alterations of cognitive functions

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Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia

Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the \u201cDelirium Day\u201d study, a nationwide Italian point-prevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors