Apathy in amyotrophic lateral sclerosis: insights from Dimensional Apathy Scale

<p><i>Objectives</i>: Apathy is associated with cognitive decline and worse survival in amyotrophic lateral sclerosis (ALS); an accurate evaluation of this aspect is relevant in clinical settings. The aims of this study are to evaluate the prevalence of apathy in a large ALS sample, using published diagnostic criteria, and to explore the psychometric properties, the sensitivity and the specificity of the Dimensional Apathy Scale (DAS) as a screening tool for apathy.</p> <p><i>Methods</i>: One hundred and thirty-one patients underwent clinical interview based on diagnostic criteria for apathy, DAS, Apathy Evaluation Scale, and assessment of depression, global cognitive functioning, and non-verbal intelligence.</p> <p><i>Results</i>: According to diagnostic criteria, apathy occurred in 28.2% of the patients. The DAS showed high consistency, convergent, and discriminant validities. Apathetic and non-apathetic patients significantly differed on total DAS and executive and Behavioral/Cognitive Initiation subscales, indicating good criterion validity. Receiver operating characteristics analysis, considering diagnostic criteria for apathy as gold standard, revealed that a score of 26/27 was an optimal cut-off score for the identification of apathy.</p> <p><i>Conclusions</i>: The DAS is a valid screening tool for apathy and its aspects in ALS through limiting the impact of physical disability. Executive and behavioral/cognitive aspects of apathy, rather than emotional aspects, are more frequent in ALS.</p

Table_1_Visual vertical neglect in acquired brain injury: a systematic review.DOCX

Vertical neglect represents a visuospatial deficit occurring as a possible consequence of acquired brain injury (ABI). Differently from unilateral spatial neglect on horizontal space, vertical neglect is poorly studied in the literature and rarely assessed in clinical practice. In the available studies, the terms “radial,” “vertical,” and “altitudinal” neglect are often used interchangeably, although they do not describe the same spatial dimension. “Altitudinal” and “vertical” refer to the sagittal plane, whereas “radial” refers to the transverse plane. The term “vertical” is sometimes used interchangeably with respect to both axes. The aim of this systematic review was to identify the main characteristics of vertical neglect after ABI, the diagnostic tools used, and the treatment options. We also proposed a clarification of the manifestations and characteristics of vertical and radial neglect. The 23 articles reviewed, showed that the vertical neglect occurred more frequently on the lower space than on the upper space, that its presence was associated with horizontal neglect, and that it could also occur with compromise of the radial space, with the near radial being more common. The most frequent etiology associated with vertical neglect is vascular, particularly ischaemic. The lesions side are very heterogeneous and include both cortical and subcortical areas and all lobes, although the temporal lobe is most affected. With regard to the assessment tools, paper and pencil tasks are the most commonly used diagnostic tools to identify vertical neglect, although in recent years the use of computer-based tasks increased. Taken together, our results suggest that vertical neglect may be underestimated in patients with right hemisphere lesions and should always be assessed, especially in cases where the patient shows signs of horizontal neglect. The clinical assessment of vertical neglect is very important since it can lead to important functional limitations in everyday life, such as poor wheelchair handling, stumbling over unnoticed obstacles located below (or above), walking down stairs, taking off shoes.</p

Supplementary material 1 -Supplemental material for Prospective memory is dysfunctional in migraine without aura

<p>Supplemental material, Supplementary material 1 for Prospective memory is dysfunctional in migraine without aura by Gabriella Santangelo, Antonio Russo, Alessandro Tessitore, Federica Garramone, Marcello Silvestro, Maria Rosaria Della Mura, Laura Marcuccio, Ilaria Fornaro, Luigi Trojano, Gioacchino Tedeschi in Cephalalgia</p

Neuropsychological assessment in different King's clinical stages of amyotrophic lateral sclerosis

<p>Emerging evidence shows that cognitive deficits associated with frontal lobe dysfunction occur from early stages of amyotrophic lateral sclerosis (ALS). We aimed to assess neuropsychological functioning at different stages of ALS to further delineate the occurrence of cognitive impairment alongside the trajectory of ALS as defined by standard assessment procedures. We investigated several cognitive domains in 74 ALS patients classified into four different clinical stages of disease, according to a recently validated staging system for ALS (known as ‘King's’ system), and evaluated and compared the corresponding cognitive profiles. We found that data derived from global cognitive assessment and several executive (i.e. Frontal Assessment Battery and Trail Making Test B-A) and long-term memory (i.e. memory prose) tests were significantly different among the subsets of ALS patients, showing poorer performances with increasing clinical disability. In conclusion, our preliminary results support the notion that mainly frontotemporal abilities may be impaired during the ALS course and suggest that neuropsychological information could supplement the current clinical staging of patients. However, ALS-specific multi-domain screening instruments, which allow to correct neuropsychological scores for physical disability, should be validated in larger populations worldwide and routinely introduced in clinical practice.</p

Significant predictors of cognitive performances in PD patients at baseline.

<p>Significant predictors of cognitive performances in PD patients at baseline.</p

Characterization of the PD cohort according to IGF-1 quartiles.

<p>Characterization of the PD cohort according to IGF-1 quartiles.</p

The characteristics of the four subgroups identified.

<p>The characteristics of the four subgroups identified.</p

Group characteristics (continuous variables) at baseline (A) and 2-year follow-up (B).

<p>Abb. UPDRS-III: Unified Parkinson’s Disease Rating Scale, motor section; MMSE: Mini Mental State Examination; FAB: Frontal Assessment battery; HADS: Hospital Anxiety Depression Scale; HADS-D: Hospital Anxiety Depression Scale-depression subscale; HADS-A: Hospital Anxiety Depression Scale-anxiety subscale; NMS: non-motor symptoms; NMS-D: non-motor domains; LEDD: Levo-dopa equivalent daily dosage.</p>a<p>different from group 4 (p<0.01).</p>b<p>different from group 1 (p<0.01).</p>c<p>different from all groups (p<0.01).</p>d<p>different from group 2 and 4 (p<0.01).</p>e<p>different from group 2 (p<0.01).</p>f<p>different from group 1 and 3 (p<0.01).</p>g<p>different from group 1 and 2 (p<0.01).</p

Summary of main features of the clusters according to clinical involvement, severity and age at onset.

<p>Summary of main features of the clusters according to clinical involvement, severity and age at onset.</p

Demographic and clinical data in the whole cohort of patients.

<p>Abb. UPDRS-III: Unified Parkinson’s Disease Rating Scale, motor section; MMSE: Mini Mental State Examination; FAB: Frontal Assessment battery; HADS: Hospital Anxiety Depression Scale; HADS-D: Hospital Anxiety Depression Scale-depression subscale; HADS-A: Hospital Anxiety Depression Scale-anxiety subscale; NMS: non-motor symptoms; NMS-D: non-motor domains.</p