Cognitive fluctuations in connection to disgraphia a comparison of Alzheimer's disease with dementia Lewy bodies

Background: The purpose of the present study was to examine the relationship between cognitive impairment and the performance of handwritten scripts presented as “letter-writing” to a close relative by patients with dementia Lewy bodies (DLB), as fluctuations of the symptoms phase, and in a matched group of patients with Alzheimer’s disease (AD). The degree of writing disability and personal, spatial, and temporal orientation was compared in these two groups. Design and methods: Fourteen simple questions, designed in a form that could be utilized by any general practitioner in order to document the level of cognitive functioning of each patient, were presented to 30 AD patients and 26 DLB patients. The initial cognition test was designated PQ1. The patients were examined on tests of letter-writing ability. Directly after the letter-writing, the list of 14 questions presented in PQ1 was presented again in a repeated procedure that was designated PQ2. The difference between these two measures (PQ1 – PQ2) was designated D∆. This test of letter-writing ability and cognitive performance was administered over 19 days. Results: Several markedly strong relationships between dysgraphia and several measures of cognitive performance in AD patients and DLB patients were observed, but the deterioration of performance from PQ1 to PQ2 over all test days were markedly significant in AD patients and not significant in DLB patients. It is possible that in graphic expression even by patients diagnosed with moderate to relatively severe AD and DLB there remains some residual capacity for understanding and intention that may be expressed. Furthermore, the deterioration in performance and the differences noted in AD and DLB patients may be due to the different speed at which the process of the protein degradation occurs for functional modification of synapses. Conclusion: Our method can be used as part of neuropsychological tests to differentiate the diagnosis between AD and DL

Cardiac hypertrophy and heart failure: from the case to review of literature

In response to an increased workload due to physiological or pathological stimuli, the heart may undergo a process of growth with increased muscle mass called cardiac hypertrophy. It is a particular mechanism of long term compensation used by the heart to adapt permanently to a greater workload. Although, through its peculiar structural, molecular and metabolic characteristics, in early stage the hypertrophy allows to maintain an adequate cardiac function, after a variable period of time, the same characteristics promote the evolution to contractile dysfunction and heart failure. The latter represents an important cause of death and so the cardiac hypertrophy increases the cardiovascular morbidity and mortality. In this paper we report a rare case of extremely high degree of concentric cardiac hypertrophy, with a heart weight of 1050 g and longitudinal diameter of 16.5 cm, transverse diameter of 16 cm and antero-posterior diameter of 9 cm. The thickness of the left ventricle free wall was 4.2 cm, of the septum 4.3 cm and at the apex level 3.5 cm. These data, compared with those described in scientific literature, indicate the exceptional nature of our necropsy finding of a huge cardiac hypertrophy. The analysis of the pathogenetic mechanisms, which may determinate the fatal event in case of cardiac hypertrophy, shows that in the described case the death cause can be the onset of heart failure in presence of cardiomegaly

Legal medical consideration of alzheimer’s disease patients’ dysgraphia and cognitive dysfunction: a 6 month follow up

Background: The purpose of this study was to investigate the ability of Alzheimer’s disease (AD) patients to express intentions and desires, and their decision-making capacity. This study examines the findings from a 6-month follow-up of our previous results in which 30 patients participated. Materials and methods: The patient’s cognition was examined by conducting the tests of 14 questions and letter-writing ability over a period of 19 days, and it was repeated after 6 months. The difference between these two cognitive measures (PQ1 before–PQ2 before), tested previously and later the writing test, was designated DΔ before. The test was repeated after 6 months, and PQ1 after–PQ2 after was designated DΔ after. Results: Several markedly strong relationships between dysgraphia and other measures of cognitive performance in AD patients were observed. The most aged patients (over 86 years), despite less frequency, maintain the cognitive capacity manifested in the graphic expressions. A document, written by an AD patient presents an honest expression of the patient’s intention if that document is legible, clear, and comprehensive. Conclusion: The identification of impairment/deficits in writing and cognition during different phases of AD may facilitate the understanding of disease progression and identify the occasions during which the patient may be considered sufficiently lucid to make decisions. Keywords: cognition, intentions, unfit to plead, consen

Dysgraphia in Relation to Cognitive Performance in Patients with Alzheimer’s Disease

Dysgraphia has been observed in patients presenting mild to moderate levels of Alzheimer’s disease (AD) in several studies. In the present study, 30 AD patients and 30 matched healthy controls, originating from the Lazio region, Rome, Italy, were examined on tests of letter-writing ability and cognitive performance over a series of 10 test days that extended over 19 days (Test days: 1, 3, 5, 7, 9 11, 13, 15, 17, and 19). Consistent deficits by the AD patients over the initial cognition test (PQ1), 2nd cognition test (PQ2) and the difference between them (D∆), expressing deterioration, and writing-time compared the group of healthy control subjects were obtained. Furthermore, the performances of the AD patients on the PQ1, D∆ and writing-time, but not the PQ2, tests deteriorated from the 1st five days of testing (Days 1-9) to the 2nd five days (11-19). Both AD patients’ and healthy controls’ MMSE scores were markedly and significantly correlated with performance of PQ1, writing-time and PQ2. The extent of dysgraphia and progressive deficits in the AD patients implicate multiple brain regions in the loss of functional integrity

Maxentius 3D Project

Aim of the project is to propose a full 3D model of the Circus of Maxentius in Rome encompassing all the aspects of the environment, as well as the architectural system. The Circus is part o a complex built by Maxentius at the beginning of the IV century AD. The maxentian complex is situated on the via Appia between the second and the third mile; nowadays this area is part of the Parco Regionale dell’Appina Antica, where is not possible to remove the vegetation in order to preserve the ecosystem. For this reason a large part of the Circus is covered by the vegetation, making the reconnaissance of the entire structure impossible for researchers. Starting point was the study of archaeological data, afterward the team carried on a survey on field to integrate the published data with new information useful to create a metrically correct reconstruction of the monument. To model both the landscape and the architectural structures it was used Blender, an opens source software, otherwise to model the statues it was used the 3D software ZBrusj. Each element was modeled using scientific references or, in absence of them, following likelihood criteria. The result is a metrically and scientifically correct 3D model of the Circus of Maxentius useful to study the monument from a new point of view. Integrating archaeological data and 3D graphic is possible to verify the hypothesis on the reconstruction of the monument. To propose an in-depth study complete 3D model is needed to understand the relation among the architectonic elements and the environment. A 3D model is also useful to communicate the monument to the public, in order to strength the relationship between heritage and citizens.

La responsabilità civile dei medici, fra danno da perdita di chances e disciplina dell'onere della prova dell'inadempimento professionale

Per effetto dalle sentenze 4400/04 e 13533/01 della Corte di cassazione civile, un paziente potrà ottenere comunque un risarcimento, sia pure in forma ridotta per perdita di chances, solo perché insoddisfatto dell’operato del medico, se questi non riesce a provare di essere esente da colpa. L’allargamento delle ipotesi di responsabilità medica, unitamente al regime probatorio della colpa professionale, potrebbe avere il risultato che il sanitario, in ogni rapporto con un paziente, sarà preoccupato di assicurarsi gli elementi per ricostruire in un eventuale futuro procedimento giudiziario la prova della sua diligenza. Ciò comporterebbe che una parte delle energie professionali sarebbero indirizzate a salvaguardare la sua tranquillità piuttosto che la salute del malato, anche perché le compagnie di assicurazione, che ormai già non mostrano eccessiva disponibilità nei confronti della classe medica, non troverebbero conveniente assumere rischi tanto alti. Se si vuole evitare che un ampliamento della responsabilità professionale porti a comportamenti di "medicina difensiva" che nuocciono alla salute del cittadino, si deve giungere a contemperare i vari interessi che la materia sottende, mediante approfondimenti dottrinari e giurisprudenziali e, soprattutto, mediante un’«assicurazione sociale», assicurazione che esiste ad esempio in Norvegia, Svezia, Finlandia, Danimarca e Francia, contro le conseguenze dannose insorte in relazione a trattamenti medici

Acute respiratory failure in pulmonary congestion: case report and review

Pulmonary Congestion (PC) is one of the most important causes of death in patients with heart failure which can be induced by a functional disorder no macroscopic appreciable in the examination of the heart. The authors present a case of edema and Respiratory Failure (RF) by PC in absence of clear and significant cardiac pathological elements in autopsy. Before the edema and then the PC act through an atelectasic mechanism that can be the cause of RF. The PC is often underestimated in the necropsy findings rather than being considered the main cause of death both in the case of objective cardiac injuries that in functional cardiac deaths.Pulmonary Congestion (PC) is one of the most important causes of death in patients with heart failure which can be induced by a functional disorder no macroscopic appreciable in the examination of the heart. The authors present a case of edema and Respiratory Failure (RF) by PC in absence of clear and significant cardiac pathological elements in autopsy. Before the edema and then the PC act through a atelectasic mechanism that can be the cause of RF. The PC is often underestimated in the necropsy findings rather than being considered the main cause of death both in the case of objective cardiac injuries that in functional cardiac deaths

Considerazioni sulla cocaina: presentazione ed analisi di una casistica

L’uso di cocaina costituisce un serio pericolo per la salute ed il nostro Paese ha previsto una dettagliata normativa in materia con il DPR 309/90, modificato a seguito del referendum del 1993 con il quale è stato depenalizzato il possesso di droga finalizzato all’uso personale, riconosciuto sulla base di specifiche dosi al momento del sequestro. Nel caso della cocaina, per la quale il limite da non superare per riconoscersi come utilizzatore e non spacciatore è rappresentato dal limite di 750 mg di principio attivo, particolare importanza ai fini dei pericoli per la salute riveste la quantità di adulterante contenuto nella dose. Il lavoro propone alcune considerazioni in merito alla prevalenza di adulteranti nel mercato degli stupefacenti in particolare per la cocaina nel territorio regionale laziale attraverso un report dell’attività di laboratorio dell’Agenzia Regionale Protezione Ambientale del Lazio, al fine di trarre utili considerazioni anche in merito al trattamento del paziente in uno stato di intossicazione. L’usage de cocaïne représente un danger pour la santé et notre pays a prévu une norme détaillée en la matière, le DPR n° 309/90, modifié suite à un référendum abrogatif en 1993 qui a dépénalisé la détention de drogue pour usage personnel (ce dernier est reconnu sur la base de la quantité de drogue au moment de la saisie). En ce qui concerne la cocaïne, la limite à ne pas dépasser pour être reconnu comme utilisateur et non comme dealer est 750 mg de principe actif ; en outre, la quantité de substance altérant la dose est particulièrement importante. Cette étude propose des considérations sur la prévalence de substances qui altèrent les doses sur le marché des stupéfiants, en particulier en ce qui concerne la cocaïne dans la région du Latium à travers l’analyse des activités du laboratoire de l’Agence Régionale de la Protection de l’Environnement du Latium, afin de développer des considérations utiles aussi au traitement du patient intoxiqué. Cocaine consumption represents a serious danger for human health and our Country has provided a detailed set of rules to this regard by DPR 309/90 amended after the referendum of 1993 which decriminalizes the possession of drug for personal use according to established amounts during confiscation. As far as cocaine is concerned the established limited quantity is 750 mg of main active ingredient (so as to be considered consumer and not drug-dealer). What is particularly important is the amount of adulterants contained in the drug dose, which is particularly dangerous and harmful. This study proposes some considerations about the prevalence of adulterants in drug-trafficking in particularly in cocaine in Lazio region through the laboratory sampling tests of the Agenzia Regionale Protezione Ambiente del Lazio, in order to draw useful considerations regarding the treatment of intoxicated patients