Posterior cortical atrophy and Alzheimer’s disease : a meta-analytic review of neuropsychological and brain morphometry studies

This paper presents the first systematic review and meta-analysis of neuropsychological and brain morphometry studies comparing posterior cortical atrophy (PCA) to typical Alzheimer's disease (tAD). Literature searches were conducted for brain morphometry and neuropsychological studies including a PCA and a tAD group. Compared to healthy controls (HC), PCA patients exhibited significant decreases in temporal, occipital and parietal gray matter (GM) volumes, whereas tAD patients showed extensive left temporal atrophy. Compared to tAD patients, participants with PCA showed greater GM volume reduction in the right occipital gyrus extending to the posterior lobule. In addition, PCA patients showed less GM volume loss in the left parahippocampal gyrus and left hippocampus than tAD patients. PCA patients exhibit significantly greater impairment in Immediate Visuospatial Memory as well as Visuoperceptual and Visuospatial Abilities than patients with tAD. However, tAD patients showed greater impairment in Delayed Auditory/Verbal Memory than patients with PCA. PCA is characterized by significant atrophy of the occipital and parietal regions and severe impairments in visuospatial functioning.JA is funded by a doctoral grant from the Foundation for Science and Technology, FCT (SFRH/BD/64457/2009, co-funded by FSE/POPH). JA and AS are funded by project PIC/IC/83290/2007, which is supported by FEDER (POFC-COMPETE) and FCT. JMS is supported by a fellowship of the project SwitchBox-FP7-HEALTH-2010-grant 259772-2. These organizations had no role in the study design, data collection, analysis, interpretation, or in the decision to submit the paper for publication

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

Aβ Imaging: feasible, pertinent, and vital to progress in Alzheimer’s disease

status: publishe

Amyloid imaging in the differential diagnosis of dementia: review and potential clinical applications

In the past decade, positron emission tomography (PET) with carbon-11-labeled Pittsburgh Compound B (PIB) has revolutionized the neuroimaging of aging and dementia by enabling in vivo detection of amyloid plaques, a core pathologic feature of Alzheimer's disease (AD). Studies suggest that PIB-PET is sensitive for AD pathology, can distinguish AD from non-AD dementia (for example, frontotemporal lobar degeneration), and can help determine whether mild cognitive impairment is due to AD. Although the short half-life of the carbon-11 radiolabel has thus far limited the use of PIB to research, a second generation of tracers labeled with fluorine-18 has made it possible for amyloid PET to enter the clinical era. In the present review, we summarize the literature on amyloid imaging in a range of neurodegenerative conditions. We focus on potential clinical applications of amyloid PET and its role in the differential diagnosis of dementia. We suggest that amyloid imaging will be particularly useful in the evaluation of mildly affected, clinically atypical or early age-at-onset patients, and illustrate this with case vignettes from our practice. We emphasize that amyloid imaging should supplement (not replace) a detailed clinical evaluation. We caution against screening asymptomatic individuals, and discuss the limited positive predictive value in older populations. Finally, we review limitations and unresolved questions related to this exciting new technique

Reducing Fertilizer and Avoiding Herbicides in Oil Palm Plantations—Ecological and Economic Valuations

Oil palm plantations are intensively managed agricultural systems that increasingly dominate certain tropical regions. Oil palm monocultures have been criticized because of their reduced biodiversity compared to the forests they historically replaced, and because of their negative impact on soils, water, and climate. We experimentally test whether less intensive management schemes may enhance biodiversity and lessen detrimental effects on the environment while maintaining high yields. We compare reduced vs. conventional fertilization, as well as mechanical vs. chemical weed control (with herbicides) in a long-term, full-factorial, multidisciplinary experiment. We conducted the experiment in an oil palm company estate in Sumatra, Indonesia, and report the results of the first 2 years. We measured soil nutrients and functions, surveyed above- and below-ground organisms, tracked oil palm condition and productivity, and calculated plantation gross margins. Plants, aboveground arthropods, and belowground animals were positively affected by mechanical vs. chemical weed control, but we could not detect effects on birds and bats. There were no detectable negative effects of reduced fertilization or mechanical weeding on oil palm yields, fine roots, or leaf area index. Also, we could not detect detrimental effects of the reduced fertilization and mechanical weeding on soil nutrients and functions (mineral nitrogen, bulk density, and litter decomposition), but water infiltration and base saturation tended to be higher under mechanical weeding, while soil moisture, and microbial biomass varied with treatment. Economic performance, measured as gross margins, was higher under reduced fertilization. There might be a delayed response of oil palm to the different management schemes applied, so results of future years may confirm whether this is a sustainable management strategy. Nevertheless, the initial effects of the experiment are encouraging to consider less intensive management practices as economically and ecologically viable options for oil palm plantations

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian Consensus Conference on Pain in Neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

A Smooth Approximation of Mobile Platform Displacement for Mobile Haptic Interfaces

One of most interesting aspects in haptic research deals with the extension of application workspace, thus allowing haptic simulation within large virtual environments. Several devices have been realized that allow this kind of interaction, in particular our interest focuses on mobile haptic interfaces, realized by combining classic grounded haptic devices with mobile platforms. While grounded haptic interfaces feature fast sampling rate and finest quantization, mobile haptic interfaces are multirate devices where the displacement sampling of mobile platform may affect the quality of haptic rendering. In this paper we introduce a simple smoothing algorithm that allows to approximate a slow-rate and roughquantized sampled signal representing mobile robot displacement with a fast rate and smooth signal. Evaluation experiments confirmed that the proposed algorithm allows to preserve a good quality of haptic rendering

Iterative estimation of the end-effector apparent gravity force for 3DoF impedance haptic devices

The position-dependent apparent gravity acting on the end-effector of impedance haptic devices may represent a loss of transparency, and generally requires to be actively compensated. To that purpose, a new approach to the problem of gravity compensation was introduced in our previous work [1]. The apparent gravity is preliminarily estimated in a given set of positions inside the workspace, then the acquired data are used to set up a suitable gravity compensation control law. At each position of the aforementioned set, the estimation is performed via an iterative method based on a nonlinear model subject to a feedback-linearizing PD controller. This paper, which builds upon our previous contribution, improves the mathematical formulation of the problem and addresses the analysis of stability and convergence properties of the iterative estimation method. Finally guidelines for performancebased parameter design are discussed. Validation experiments have been performed, and results are in good agreement with theoretical findings