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Background: Poor affect recognition is an early sign of frontotemporal dementia (FTD). Here, we applied the abbreviated version of the Comprehensive Affect Testing System (CATS-A) battery to Italian FTD cases and healthy controls (HC) to provide cut-offs of emotional dysfunction in the whole group and in different FTD clinical syndromes., Methods: One hundred thirty-nine FTD patients (60 behavioural variant [bvFTD],13 semantic behavioural variant of FTD [sbvFTD], 28 progressive supranuclear palsy [PSP], 21 semantic [svPPA] and 17 nonfluent [nfvPPA] variants of primary progressive aphasia) and 116 HC were administered the CATS-A, yielding an Affective Recognition Quotient (ARQ), which was used as outcome measure. Age- and education-adjusted, regression-based norms were derived in HC. In patients, the ARQ was assessed for its internal reliability, factorial validity and construct validity by testing its association with another social cognition paradigm, the Story-Based Empath Task (SET). The diagnostic accuracy of the ARQ in discriminating patients from HC, genetic cases from HC and patient groups among each other was tested via ROC analyses., Results: In the whole FTD cohort, CATS-A proved to be underpinned by a mono-component factor (51.1%) and was internally consistent (McDonald's ω = 0.76). Moreover, the ARQ converged with the SET (r(122) = 0.50; p < 0.001) and optimally discriminated HC from both the whole cohort (AUC = 0.89) and each clinical syndrome (AUC range: 0.83-0.92). Conversely, CATS-A subtests were able to distinguish patient groups., Conclusions: The ARQ score from the CATS-A distinguishes FTD clinical syndromes from HC with high accuracy, making it an excellent tool for immediate use in clinical practice., (© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Background: Data on the efficacy of perampanel in refractory status epilepticus (RSE) and postanoxic encephalopathy (PAE) are limited; its use in such conditions is currently off-label., Methods: We conducted a retrospective cohort study of consecutive adult patients with RSE, including PAE, exhibiting electroencephalographic patterns indicative of status epilepticus who were treated at our center (January 2018 to December 2022) with assessment of clinical and electroencephalographic outcomes., Results: Thirty-six patients were included in the study, of whom 29 had nonanoxic RSE and 7 had PAE. Within the nonanoxic RSE subgroup, 45% (13 of 29; 95% confidence interval [CI] 27-63%) of study participants were responders, 34% (10 of 29; 95% CI 17-52%) were partial responders, and 21% (6 of 29; 95% CI 6-35%) were nonresponders. In the PAE subgroup (n = 7), no patients fully responded to perampanel; 43% (3 of 7; 95% CI 6-80%) were partial responders, and 57% (4 of 7; 95% CI 20-95%) were nonresponders. Responder and nonresponder study participants exhibited overlapping baseline characteristics. No significant differences in duration of hospitalization were observed between responders and nonresponders in both subgroups. Responders in the RSE subgroup had a median discharge modified Rankin Scale score of 3 (interquartile range 3-4), and nonresponders had a median discharge modified Rankin Scale score of 5 (interquartile range 5-6)., Conclusions: Despite limitations from the retrospective design and the small population size, this study suggests that perampanel use in nonanoxic RSE appears to yield promising results at moderate doses, including a tendency toward a better functional outcome at discharge, without significant adverse effects. However, in patients with PAE, the drug seems to show suboptimal performance. Perampanel appears to have promising efficacy as an add-on therapy in nonanoxic RSE. However, in patients with PAE, its efficacy seems to be lower. Further studies are warranted to confirm these observations., Competing Interests: Conflicts of Interest: The authors have no disclosures related to the present work. Potential conflicts of interest outside the submitted work are as follows: Massimo Filippi is editor-in-chief of the Journal of Neurology and associate editor of Human Brain Mapping, Neurological Sciences, and Radiology; received compensation for consulting services from Alexion, Almirall, Biogen, Merck, Novartis, Roche, and Sanofi; received compensation for speaking activities from Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA; received compensation for participation in advisory boards for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, and Takeda; received compensation for scientific direction of educational events for Biogen, Merck, Roche, Celgene, Bristol-Myers Squibb, Lilly, Novartis, and Sanofi-Genzyme; and received research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla. The other authors have nothing to disclose. Ethical Approval/Informed Consent: The present study was conducted in accordance with the Helsinki Declaration (Fortaleza revision, 2013) and with European and Italian regulations about privacy. Informed consent was obtained from the patients or their representatives if incapacitated., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.)

The finely tuned regulation of mitochondria activity is essential for proper brain development. Fragile X Syndrome (FXS), the leading cause of inherited intellectual disability, is a neurodevelopmental disorder in which mitochondrial dysfunction has been increasingly implicated. This study investigates the role of Glycogen Synthase Kinase 3β (GSK3β) in FXS. Several studies have reported the dysregulation of GSK3β in FXS, and its role in mitochondrial function is also well established. However, the link between disrupted GSK3β activity and mitochondrial dysfunction in FXS remains unexplored. Utilizing Fmr1 knockout (KO) mice and human cell lines from individuals with FXS, we uncovered a developmental window where dysregulated GSK3β activity disrupts mitochondrial function. Notably, a partial inhibition of GSK3β activity in FXS fibroblasts from young individuals rescues the observed mitochondrial defects, suggesting that targeting GSK3β in the early stages may offer therapeutic benefits for this condition., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:, (Copyright © 2024. Published by Elsevier Inc.)

The ability to predict the pathology spreading in patients with frontotemporal dementia (FTD) is crucial for early diagnosis and targeted interventions. This study examined the relationship between network vulnerability and longitudinal atrophy progression in FTD patients, using Network Diffusion Model (NDM) of pathology spread. Thirty behavioural-variant FTD (bvFTD), 13 semantic-variant primary progressive aphasia (svPPA), 14 nonfluent-variant PPA (nfvPPA) and 12 semantic behavioral variant FTD (sbvFTD) patients underwent longitudinal T1-weighted MRI. Fifty young controls (YC) (20-31 years) underwent multi-shell diffusion MRI scan. NDM was developed to model FTD pathology progression as a spreading process from a seed through the healthy structural connectome, using connectivity measures from fractional anisotropy (FA) and intra-cellular volume fraction (ICVF) in YC. Four disease epicenters were initially identified from the peaks of atrophy of each FTD variant: left insula (bvFTD), left temporal pole (svPPA), right temporal pole (sbvFTD) and left supplementary motor area (nfvPPA). Pearson's correlations were calculated between NDM-predicted atrophy in YC and the observed longitudinal atrophy in FTD patients over a follow-up of 24 months. The NDM was then run for all the 220 brain seeds to verify whether the four epicenters were among those that yielded the highest correlation. Using NDM, predictive maps in YC showed pathology progression from the peaks of atrophy in svPPA, nfvPPA, and sbvFTD over 24-months. svPPA exhibited early involvement of left temporal and occipital lobes, progressing to extensive left hemisphere impairment. nfvPPA and sbvFTD similarly spread bilaterally to frontal, sensorimotor, and temporal regions, with sbvFTD additionally affecting the right hemisphere. Moreover, the NDM-predicted atrophy of each region was positively correlated to longitudinal real atrophy, with a greater effect in svPPA and sbvFTD. In bvFTD, the model starting from the left insula (the peak of atrophy) demonstrated a highly left-lateralized pattern, with pathology spreading to frontal, sensorimotor, temporal, and basal ganglia regions, with minimal extension to the contralateral hemisphere by 24 months. However, unlike the atrophy peaks observed in the other three phenotypes, the left insula did not show the strongest correlation between the estimated and actual atrophy. Instead, the bilateral superior frontal gyrus emerged as optimal seeds for modelling atrophy spread, showing the highest correlation ranking in both hemispheres. Overall, NDM applied on ICVF connectome yielded higher correlations relative to NDM applied on FA maps. The NDM implementation using cross-sectional structural connectome is a valuable tool to predict atrophy patterns and pathology spreading in FTD clinical variants., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Guarantors of Brain.)

Background and Purpose: Precise and timely diagnosis is crucial for the optimal use of emerging disease-modifying treatments for Alzheimer disease (AD). Electroencephalography (EEG), which is noninvasive and cost-effective, can capture neural abnormalities linked to various dementias. This study explores the use of individual alpha frequency (IAF) derived from EEG as a diagnostic and prognostic tool in cognitively impaired patients., Methods: This retrospective study included 375 patients from the tertiary Memory Clinic of IRCCS San Raffaele Hospital, Milan, Italy. Participants underwent clinical and neuropsychological assessments, brain imaging, cerebrospinal fluid biomarker analysis, and resting-state EEG. Patients were categorized by amyloid status, the AT(N) classification system, clinical diagnosis, and mild cognitive impairment (MCI) progression to AD dementia. IAF was calculated and compared among study groups. Receiver operating characteristic (ROC) analysis was used to calculate its discriminative performance., Results: IAF was higher in amyloid-negative subjects and varied significantly across AT(N) groups. ROC analysis confirmed IAF's ability to distinguish A-T-N- from the A+T+N+ and A+T-N+ groups. IAF was lower in AD and Lewy body dementia patients compared to MCI and other dementia types, with moderate discriminatory capability. Among A+ MCI patients, IAF was significantly lower in those who converted to AD within 2 years compared to stable MCI patients and predicted time to conversion (p < 0.001, R = 0.38)., Conclusions: IAF is a valuable tool for dementia diagnosis and prognosis, correlating with amyloid status and neurodegeneration. It effectively predicts MCI progression to AD, supporting its use in early, targeted interventions in the context of disease-modifying treatments., (© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Background and Objectives: This study evaluates the discriminative performance of the automated Lumipulse plasma pTau-217 compared to plasma pTau-181 and the Aβ42/Aβ40 ratio across cerebrospinal fluid (CSF) A/T classes and diagnostic groups within a memory-center-based population of cognitively impaired patients., Methods: This cross-sectional study in a Memory Center enrolled 98 patients along the AD continuum or affected by other neurodegenerative disorders, stratified by CSF A/T status and clinical syndrome. Plasma pTau-217, pTau-181, and Aβ42/Aβ40 were measured using Lumipulse. Relationships with CSF and glomerular filtration rate (GFR) were explored. ROC analysis was conducted to assess diagnostic performance., Results: The CSF A/T profiles included 49 A+/T+, 8 A+/T-, and 41 A-/T-. Clinical diagnoses at discharge were AD-dementia (AD-DEM), AD-MCI, NonAD-MCI, and NonAD-dementia (NonAD-DEM). Plasma pTau-217 and the pTau-217/Aβ42 ratio strongly correlated with CSF pTau-181 and total Tau (R = 0.80). GFR had minimal influence on plasma biomarker ratios. Plasma pTau-217 exhibited excellent AUC values (0.94-0.97) for distinguishing CSF A+/T+ and A+ status, showing higher discriminative accuracy than pTau-181 and Aβ42/Aβ40 (AUCs: 0.66-0.83). Optimal cutoff for plasma pTau-217 indicated excellent accuracy (93.3%), sensitivity (91.8%), and specificity (95.1%). AD-DEM patients displayed the highest pTau-217 levels, with significant differences across clinical groups., Discussion: The findings confirm that Lumipulse plasma pTau-217 offers superior diagnostic accuracy for reflecting CSF A/T status. Plasma pTau-217 emerged as an accurate standalone biomarker of AD neuropathology across MCI and dementia stages. The study underscores the utility of automated Lumipulse assays, promoting their integration into routine diagnostic workflows to facilitate early and accurate AD detection., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Stepwise functional connectivity (SFC) detects whole-brain functional couplings of a selected region of interest at increasing link-step topological distances., Objective: This study applied SFC to test the hypothesis that stepwise architecture propagating from the disease epicenter would shape patterns of brain atrophy in patients with progressive supranuclear palsy-Richardson's syndrome (PSP-RS)., Methods: Thirty-six patients with PSP-RS and 44 age-matched healthy control subjects underwent brain magnetic resonance imaging on a 3-T scanner. The disease epicenter was defined as the peak of atrophy observed in an independent cohort of 13 cases with postmortem confirmation of PSP pathology and used as seed region for SFC analysis. First, we explored SFC rearrangements in patients with PSP-RS, as compared with age-matched control subjects. Subsequently, we tested SFC architecture propagating from the disease epicenter as a determinant of brain atrophy distribution., Results: The disease epicenter was identified in the left midbrain tegmental region. Compared with age-matched control subjects, patients with PSP-RS showed progressively widespread decreased SFC of the midbrain with striatal and cerebellar regions through direct connections and sensorimotor cortical regions through indirect connections. A correlation was found between average link-step distance from the left midbrain in healthy subjects and brain volumes in patients with PSP-RS (r = 0.38, P < 0.001)., Conclusions: This study provides comprehensive insights into the topology of functional network rearrangements in PSP-RS and demonstrates that the brain architectural topology, as described by SFC propagating from the disease epicenter, shapes the pattern of atrophic changes in PSP-RS. Our findings support the view of a network-based pathology propagation in this primary tauopathy. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society., (© 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Background and Objectives: Epileptic seizures pose challenges in emergency departments (ED), affecting up to 10% of admitted patients. This study aimed to assess emergency electroencephalogram (EmEEG) utilization, identifying factors predicting seizure detection and its influence on clinical decisions., Methods: A retrospective review of 1135 EmEEGs on 1017 patients at a tertiary teaching hospital between June 2022 and June 2023 was conducted. Data included demographics, medical history, EmEEG indications, neuroimaging findings, and clinical outcomes. Statistical analyses utilized Fisher's exact tests and logistic regression models., Results: EmEEG detected status epilepticus-related seizures in 5.40% of cases, seizures without status epilepticus in 3.05%, and status epilepticus without discrete seizures in 3.74%. Epileptiform abnormalities were noted in 22.12% of EmEEGs. EmEEG influenced initial diagnoses (21.24%), antiseizure medication changes (20.85%), and discharge decisions (39.04%). Predictors for seizures/status epilepticus included previous neurosurgery, seizures in the ED, and cognitive/behavioral impairment (p < 0.001). EmEEG significantly altered initial diagnoses based on witnessed seizures, involuntary movements, epileptiform abnormalities, and 1-2 Hz generalized periodic discharges (p < 0.001). Changes in antiseizure medications correlated with seizure occurrence, neuroimaging results, epileptiform abnormalities, and EEG background slowing (p < 0.001). Factors influencing discharge decisions included previous neurosurgery, consciousness impairment, acute neuroimaging pathology, EEG focal slowing, and EEG background slowing (p < 0.001)., Discussion: The study clarifies EmEEG's role in modifying initial diagnoses, treatment approaches, and discharge decisions. The study provides insights into the nuanced impact of EmEEG in different clinical scenarios, offering valuable guidance for clinicians in selecting patients for EmEEG, particularly in conditions of limited EEG availability., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

Linguistic research showed that the depth of syntactic embedding is reflected in brain theta power. Here, we test whether this also extends to non-linguistic stimuli, specifically music. We used a hierarchical model of musical syntax to continuously quantify two types of expert-annotated harmonic dependencies throughout a piece of Western classical music: prolongation and preparation. Prolongations can roughly be understood as a musical analogue to linguistic coordination between constituents that share the same function (e.g., 'pizza' and 'pasta' in 'I ate pizza and pasta'). Preparation refers to the dependency between two harmonies whereby the first implies a resolution towards the second (e.g., dominant towards tonic; similar to how the adjective implies the presence of a noun in 'I like spicy … '). Source reconstructed MEG data of sixty-five participants listening to the musical piece was then analysed. We used Bayesian Mixed Effects models to predict theta envelope in the brain, using the number of open prolongation and preparation dependencies as predictors whilst controlling for audio envelope. We observed that prolongation and preparation both carry independent and distinguishable predictive value for theta band fluctuation in key linguistic areas such as the Angular, Superior Temporal, and Heschl's Gyri, or their right-lateralised homologues, with preparation showing additional predictive value for areas associated with the reward system and prediction. Musical expertise further mediated these effects in language-related brain areas. Results show that predictions of precisely formalised music-theoretical models are reflected in the brain activity of listeners which furthers our understanding of the perception and cognition of musical structure., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Semantic behavioral variant frontotemporal dementia (sbvFTD) is a neurodegenerative condition presenting with specific behavioral and semantic derangements and predominant atrophy of the right anterior temporal lobe (ATL). The objective was to evaluate clinical, neuropsychological, neuroimaging, and genetic features of an Italian sbvFTD cohort, defined according to recently proposed guidelines, compared to semantic variant primary progressive aphasia (svPPA) and behavioral variant FTD (bvFTD) patients., Methods: Fifteen sbvFTD, sixty-three bvFTD, and twenty-five svPPA patients and forty controls were enrolled. Patients underwent clinical, cognitive evaluations, and brain MRI. Symptoms of bvFTD patients between onset and first visit were retrospectively recorded and classified as early and late. Grey matter atrophy was investigated using voxel-based morphometry., Results: sbvFTD experienced early criteria-specific symptoms: world, object and person-specific semantic loss (67%), complex compulsions and rigid thought (60%). Sequentially, more behavioral symptoms emerged (apathy/inertia, loss of empathy) along with non-criteria-specific symptoms (anxiety, suspiciousness). sbvFTD showed sparing of attentive/executive functions, especially compared to bvFTD and better language functions compared to svPPA. All sbvFTD patients failed at the famous face recognition test and more than 80% failed in understanding written metaphors and humor. At MRI, sbvFTD had predominant right ATL atrophy, almost specular to svPPA. Three sbvFTD patients presented pathogenic genetic variants., Conclusion: We replicated the application of sbvFTD diagnostic guidelines in an independent Italian cohort, demonstrating that the presence of person-specific semantic knowledge loss and mental rigidity, along with preserved executive functions and a predominant right ATL atrophy with sparing of frontal lobes, should prompt a diagnosis of sbvFTD., (© 2024. The Author(s).)

Background and Objectives: The AT(N) classification system stratifies patients based on biomarker profiles, including amyloid-beta deposition (A), tau pathology (T), and neurodegeneration (N). This study aims to apply the AT(N) classification to a hospital-based cohort of patients with cognitive decline and/or dementia, within and outside the Alzheimer's disease (AD) continuum, to enhance our understanding of the multidimensional aspects of AD and related disorders. Furthermore, we wish to investigate how many cases from our cohort would be eligible for the available disease modifying treatments, such as aducanemab and lecanemab., Methods: We conducted a retrospective evaluation of 429 patients referred to the Memory Center of IRCCS San Raffaele Hospital in Milan. Patients underwent clinical/neuropsychological assessments, lumbar puncture, structural brain imaging, and positron emission tomography (FDG-PET). Patients were stratified according to AT(N) classification, group comparisons were performed and the number of eligible cases for anti-β amyloid monoclonal antibodies was calculated., Results: Sociodemographic and clinical features were similar across groups. The most represented group was A + T + N + accounting for 38% of cases, followed by A + T - N + (21%) and A - T - N + (20%). Although the clinical presentation was similar, the A + T + N + group showed more severe cognitive impairment in memory, language, attention, executive, and visuospatial functions compared to other AT(N) groups. Notably, T + patients demonstrated greater memory complaints compared to T -  cases. FDG-PET outperformed MRI and CT in distinguishing A + from A -  patients. Although 61% of the observed cases were A + , only 17% of them were eligible for amyloid-targeting treatments., Discussion: The AT(N) classification is applicable in a real-world clinical setting. The classification system provided insights into clinical management and treatment strategies. Low cognitive performance and specific regional FDG-PET hypometabolism at diagnosis are highly suggestive for A + T + or A - T + profiles. This work provides also a realistic picture of the proportion of AD patients eligible for disease modifying treatments emphasizing the need for early detection., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background and Objectives: The 3 clinical presentations of primary progressive aphasia (PPA) reflect heterogenous neuropathology, which is difficult to be recognized in vivo. Resting-state (RS) EEG is promising for the investigation of brain electrical substrates in neurodegenerative conditions. In this study, we aim to explore EEG cortical sources in the characterization of the 3 variants of PPA., Methods: This is a cross-sectional, single-center, memory center-based cohort study. Patients with PPA and healthy controls were consecutively recruited at the Neurology Unit, IRCCS San Raffaele Scientific Institute (Milan, Italy). Each participant underwent an RS 19-channel EEG. Using standardized low-resolution brain electromagnetic tomography, EEG current source densities were estimated at voxel level and compared among study groups. Using an RS functional MRI-driven model of source reconstruction, linear lagged connectivity (LLC) values within language and extra-language brain networks were obtained and analyzed among groups., Results: Eighteen patients with logopenic PPA variant (lvPPA; mean age = 72.7 ± 6.6; % female = 52.4), 21 patients with nonfluent/agrammatic PPA variant (nfvPPA; mean age = 71.7 ± 8.1; % female = 66.6), and 9 patients with semantic PPA variant (svPPA; mean age = 65.0 ± 6.9; % female = 44.4) were enrolled in the study, together with 21 matched healthy controls (mean age = 69.2 ± 6.5; % female = 57.1). Patients with lvPPA showed a higher delta density than healthy controls ( p < 0.01) and patients with nfvPPA ( p < 0.05) and svPPA ( p < 0.05). Patients with lvPPA also displayed a greater theta density over the left posterior hemisphere ( p < 0.01) and lower alpha2 values ( p < 0.05) over the left frontotemporal regions than controls. Patients with nfvPPA showed a diffuse greater theta density than controls ( p < 0.05). LLC was altered in all patients relative to controls ( p < 0.05); the alteration was greater at slow frequency bands and within language networks than extra-language networks. Patients with lvPPA also showed greater LLC values at theta band than patients with nfvPPA ( p < 0.05)., Discussion: EEG findings in patients with PPA suggest that lvPPA-related pathology is associated with a characteristic disruption of the cortical electrical activity, which might help in the differential diagnosis from svPPA and nfvPPA. EEG connectivity was disrupted in all PPA variants, with distinct findings in disease-specific PPA groups., Classification of Evidence: This study provides Class IV evidence that EEG analysis can distinguish PPA due to probable Alzheimer disease from PPA due to probable FTD from normal aging.

Music can be interpreted by attributing syntactic relationships to sequential musical events, and, computationally, such musical interpretation represents an analogous combinatorial task to syntactic processing in language. While this perspective has been primarily addressed in the domain of harmony, we focus here on rhythm in the Western tonal idiom, and we propose for the first time a framework for modeling the moment-by-moment execution of processing operations involved in the interpretation of music. Our approach is based on (1) a music-theoretically motivated grammar formalizing the competence of rhythmic interpretation in terms of three basic types of dependency (preparation, syncopation, and split; Rohrmeier, 2020), and (2) psychologically plausible predictions about the complexity of structural integration and memory storage operations, necessary for parsing hierarchical dependencies, derived from the dependency locality theory (Gibson, 2000). With a behavioral experiment, we exemplify an empirical implementation of the proposed theoretical framework. One hundred listeners were asked to reproduce the location of a visual flash presented while listening to three rhythmic excerpts, each exemplifying a different interpretation under the formal grammar. The hypothesized execution of syntactic-processing operations was found to be a significant predictor of the observed displacement between the reported and the objective location of the flashes. Overall, this study presents a theoretical approach and a first empirical proof-of-concept for modeling the cognitive process resulting in such interpretation as a form of syntactic parsing with algorithmic similarities to its linguistic counterpart. Results from the present small-scale experiment should not be read as a final test of the theory, but they are consistent with the theoretical predictions after controlling for several possible confounding factors and may form the basis for further large-scale and ecological testing., (© 2023 The Authors. Cognitive Science published by Wiley Periodicals LLC on behalf of Cognitive Science Society (CSS).)

Purpose of Review: Currently, three antibeta amyloid (Aβ) mAbs are approved or under examination in USA and in Europe for the treatment of patients with early Alzheimer's disease. The aim of this review is to summarize the role of MRI in the mandatory redefinition of dementia care., Recent Findings: Disease-modifying therapies require a reliable biological diagnosis of Alzheimer's disease. Structural MRI should be acquired at the beginning of the diagnostic process as a gateway before subsequent etiological biomarkers. MRI findings, indeed, may support a diagnosis of Alzheimer's disease or suggest alternative non-Alzheimer's disease conditions. Given the high risk/benefit ratio of mAbs and the impact of amyloid-related imaging abnormalities (ARIA), moreover, MRI will be crucial for the appropriate patient selection and safety monitoring. Ad-hoc neuroimaging classification systems of ARIA have been developed and continuous education of prescribers and imaging raters is prompted. MRI measures have been also assessed in clinical trials as potential markers of therapeutic efficacy; results, though, are controversial and still need clarification., Summary: Structural MRI will play a crucial role in the upcoming era of amyloid-lowering mAbs against Alzheimer's disease, from the correct patient selection to the monitoring of adverse events and of disease progression., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Interstitial 6q deletions are associated with rare genetic syndromes characterized by different signs, including developmental delay, dysmorphisms, and Prader-Willi (PWS)-like features. Drug-resistant epilepsy, a relatively rare finding in this condition, is often a challenge in terms of therapeutic approach. Our aim is to present a new case of interstitial 6q deletion and to conduct a systematic review of the literature with an emphasis on the neurophysiological and clinical traits of afflicted individuals., Methods: We report a patient with an interstitial 6q deletion. Standard electroencephalograms (EEG), video-EEG with polygraphy and MRI features are discussed. We also conducted a literature review of previously described cases., Results: We describe a relatively small interstitial 6q deletion (2 Mb circa), detected by CGH-Array, not encompassing the previously described 6q22 critical region for epilepsy occurrence. The patient, a 12-year-old girl, presented with multiple absence-like episodes and startle-induced epileptic spasms since the age of 11, with partial polytherapy control. Treatment with lamotrigine induced the resolution of startle-induced phenomena. From the literature review, we identified 28 patients with overlapping deletions, often larger than our patient's mutation. Seventeen patients presented with PWS-like features. Epilepsy was reported in 4 patients, and 8 patients presented abnormal EEG findings. In our patient, the deletion included genes MCHR2, SIM1, ASCC3, and GRIK2, but, interestingly, it did not encompass the 6q22 critical region for epilepsy occurrence. The involvement of GRIK2 in the deletion may play a role., Conclusion: Literature data are limited, and specific EEG or epileptological phenotypes cannot yet be identified. Epilepsy, although uncommon in the syndrome, deserves a specific diagnostic workup. We speculate on the existence of an additional locus in the 6q16.1-q21 region, different from the already hypothesized q22, promoting the development of epilepsy in affected patients., Competing Interests: Declaration of Competing Interest The authors have no relevant disclosures related to the present work., (Copyright © 2023. Published by Elsevier Ltd.)

No disease-modifying therapies are currently available for Alzheimer's disease (AD) in Europe. Current evidence from clinical trials testing anti-beta amyloid (Aβ) monoclonal antibodies (mAbs) in patients with early AD, though, suggests a likely marketing authorization in the next years. Since the implementation of disease-modifying therapies for AD in the clinical practice will evidently require a huge change of dementia care in all countries, a group of prominent AD clinical experts in Italy met to discuss patients' selection and management strategies. The current diagnostic-therapeutic standard of care in Italy was taken as the starting point. The prescription of new therapies cannot ignore the definition of a biological diagnosis through the assessment of both amyloid- and tau-related biomarkers. The high risk/benefit ratio of anti-Aβ immunotherapies, moreover, needs a highly specialized diagnostic work-up and a thorough exclusion criteria assessment, which should be provided by a neurology specialist. The Expert Panel also suggests a reorganization of the Centers for dementia and cognitive decline in Italy into 3 levels of increasing complexity: community center, first- and second-level center. Tasks and requirements for each level were defined. Finally, specific characteristics of a center deputed to prescribe anti-Aβ mAbs were discussed., (© 2023. The Author(s).)

Objectives: We describe brain structural damage and cognitive profile evolution of an adult patient with 17q21.31 microduplication, a rare condition associated with psychomotor delay, behavioural disturbances and poor social interaction., Methods: A.B., 57 years old, male, displayed obsessive and repetitive behaviours, irritability, scarce hygiene and memory loss at disease onset. He had strong familiarity for adult-onset behavioural alterations (his father and sister) and neuropsychiatric conditions (his son). Blood and cerebrospinal fluid (CSF) samples revealed 17q21.31 microduplication, shared also by his son and sister, and raised CSF tau, respectively. He was hospitalized 1 year after disease onset and underwent an MRI scan and a neuropsychological assessment, the latter being repeated 7 months later. To quantitatively investigate patient's grey matter (GM) volume, 16 age- and education-matched male controls were selected and voxel-based morphometry analysis was performed., Results: During hospitalization, his behavioural profile was characterized by anosognosia, impulsivity, apathy and aggressiveness. Cognitive testing revealed main attentive-executive disturbances and difficulties in understanding non-literal language. Compared to controls, A.B. had greater GM atrophy mainly in the right hemisphere, involving amygdala, hippocampus, inferior/superior temporal gyri and temporal pole. He received a diagnosis of early onset dementia. After 7 months, he developed empathy loss, perseverative behaviour, changes in eating habits and worsening in executive-attentive abilities., Conclusions: In A.B., 17q21.31 microduplication caused a neurodegenerative condition with prevalent right temporal damage, raised CSF tau level, behavioural disturbances, memory impairment, attentive-executive and abstract language dysfunctions and fast disease progression, thus reflecting the complex interaction between such genetic substrate and clinical phenotypes., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

While theoretical and empirical insights suggest that the capacity to represent and process complex syntax is crucial in language as well as other domains, it is still unclear whether specific parsing mechanisms are also shared across domains. Focusing on the musical domain, we developed a novel behavioral paradigm to investigate whether a phenomenon of syntactic revision occurs in the processing of tonal melodies under analogous conditions as in language. We present the first proof-of-existence for syntactic revision in a set of tonally ambiguous melodies, supporting the relevance of syntactic representations and parsing with language-like characteristics in a nonlinguistic domain. Furthermore, we find no evidence for a modulatory effect of musical training, suggesting that a general cognitive capacity, rather than explicit knowledge and strategies, may underlie the observed phenomenon in music., (© 2022 The Authors. Cognitive Science published by Wiley Periodicals LLC on behalf of Cognitive Science Society (CSS).)

Background and Objectives: To explore cognitive, EEG, and MRI features in COVID-19 survivors up to 10 months after hospital discharge., Methods: Adult patients with a recent diagnosis of COVID-19 and reporting subsequent cognitive complaints underwent neuropsychological assessment and 19-channel-EEG within 2 months (baseline, N = 49) and 10 months (follow-up, N = 33) after hospital discharge. A brain MRI was obtained for 36 patients at baseline. Matched healthy controls were included. Using eLORETA, EEG regional current densities and linear lagged connectivity values were estimated. Total brain and white matter hyperintensities (WMH) volumes were measured. Clinical and instrumental data were evaluated between patients and controls at baseline, and within patient whole group and with/without dysgeusia/hyposmia subgroups over time. Correlations among findings at each timepoint were computed., Results: At baseline, 53% and 28% of patients showed cognitive and psychopathological disturbances, respectively, with executive dysfunctions correlating with acute-phase respiratory distress. Compared to healthy controls, patients also showed higher regional current density and connectivity at delta band, correlating with executive performances, and greater WMH load, correlating with verbal memory deficits. A reduction of cognitive impairment and delta band EEG connectivity were observed over time, while psychopathological symptoms persisted. Patients with acute dysgeusia/hyposmia showed lower improvement at memory tests than those without. Lower EEG delta band at baseline predicted worse cognitive functioning at follow-up., Discussion: COVID-19 patients showed interrelated cognitive, EEG, and MRI abnormalities 2 months after hospital discharge. Cognitive and EEG findings improved at 10 months. Dysgeusia and hyposmia during acute COVID-19 were related with increased vulnerability in memory functions over time., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Importance: After more than a decade of research and development of clinical trials testing anti-β-amyloid monoclonal antibodies (mAbs), extensive experience has been gained regarding the effects of these treatments in patients with Alzheimer disease (AD). On the verge of an expected large-scale introduction in the clinical setting after the recent US Food and Drug Administration approval of aducanumab, shared knowledge regarding amyloid-related imaging abnormalities (ARIAs) is of paramount importance., Objective: To summarize available evidence on ARIAs from randomized clinical trials (RCTs) testing anti-β-amyloid mAbs in patients with AD and to provide a comprehensive update about risk factors, clinical correlates, and implications for withholding and reinitiating treatment., Evidence Review: In this systematic review, a literature search of MEDLINE/PubMed, Embase, and Cochrane Library and a search of ClinicalTrials.gov were conducted through September 15, 2021. Publications describing RCTs, secondary analyses of RCT data, and case reports of ARIAs were included. Strengths of clinical data were graded according to the Oxford Centre for Evidence-Based Medicine., Findings: Twenty-two RCTs, 11 secondary analyses of RCTs, and 1 case report, including in total 15 508 adult patients (8483 women [54.7%]; mean [SD] age, 69.6 [8.3] years) were selected for inclusion. Signal alterations that included parenchymal edema and sulcal effusion leading to transient hyperintensities on fluid-attenuated inversion recovery and T2-weighted sequences were termed ARIA-E, whereas those consisting of hemosiderin deposits, including parenchymal microhemorrhages and leptomeningeal superficial siderosis, were termed ARIA-H. Apolipoprotein E (ApoE) ε4 genotype was the main risk factor for both ARIA types; ARIA-E incidence was further associated with treatment dose, affecting the 55% of ApoE ε4 carriers in the high-dose aducanumab treatment group. Both ARIA types manifested early during study course, and symptomatic cases accounted for the 6.1% to 39.3% of ARIA-E cases at higher treatment doses across RCTs, whereas ARIA-H cases were generally asymptomatic. Most ARIA-E cases resolved with treatment withholding, although corticosteroid administration was required anecdotally. ARIA-E recurrence after dose reinitiation or adjustment varied from 13.8% to 25.6% across RCTs., Conclusions and Relevance: Evidence suggests that ARIAs are frequent, mostly asymptomatic collateral events of amyloid-modifying therapies, highlighting the need for standardized clinical and neuroradiological management protocols in real-world clinical settings.

Background and Objectives: A significant overlap between amyotrophic lateral sclerosis (ALS) and behavioral variant of frontotemporal dementia (bvFTD) has been observed at clinical, genetic, and pathologic levels. Within this continuum of presentations, the presence of mild cognitive or behavioral symptoms in patients with ALS has been consistently reported, although it is unclear whether this is to be considered a distinct phenotype or rather a natural evolution of ALS. Here, we used mathematical modeling of MRI connectomic data to decipher common and divergent neural correlates across the ALS-frontotemporal dementia (FTD) spectrum., Methods: We included 83 patients with ALS, 35 patients with bvFTD, and 61 healthy controls, who underwent clinical, cognitive, and MRI assessments. Patients with ALS were classified according to the revised Strong criteria into 54 ALS with only motor deficits (ALS-cn), 21 ALS with cognitive or behavioral involvement (ALS-ci/bi), and 8 ALS with bvFTD (ALS-FTD). First, we assessed the functional and structural connectivity patterns across the ALS-FTD spectrum. Second, we investigated whether and where MRI connectivity alterations of patients with ALS with any degree of cognitive impairment (i.e., ALS-ci/bi and ALS-FTD) resembled more the pattern of damage of one (ALS-cn) or the other end (bvFTD) of the spectrum, moving from group-level to single-subject analysis., Results: As compared with controls, extensive structural and functional disruption of the frontotemporal and parietal networks characterized bvFTD (bvFTD-like pattern), while a more focal structural damage within the sensorimotor-basal ganglia areas characterized ALS-cn (ALS-cn-like pattern). ALS-ci/bi patients demonstrated an ALS-cn-like pattern of structural damage, diverging from ALS-cn with similar motor impairment for the presence of enhanced functional connectivity within sensorimotor areas and decreased functional connectivity within the bvFTD-like pattern. On the other hand, patients with ALS-FTD resembled both structurally and functionally the bvFTD-like pattern of damage with, in addition, the structural ALS-cn-like damage in the motor areas., Discussion: Our findings suggest a maladaptive role of functional rearrangements in ALS-ci/bi concomitantly with similar structural alterations compared to ALS-cn, supporting the hypothesis that ALS-ci/bi might be considered as a phenotypic variant of ALS, rather than a consequence of disease worsening., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)

Background: Alzheimer's disease (AD) is characterized by a heterogeneous course. Predicting a fast rather than a slow decline over time is crucial to both provide a reliable prognosis and elaborate stricter enrolment criteria in clinical trials. Here we searched for independent predictors of cognitive decline rate to assess the risk of fast disease progression already at baseline., Methods: Fifty-three subjects with an "in-vivo biomarker confirmed" diagnosis of AD were included. Neuropsychological assessment, plasma neurofilaments (NfL) concentrations and, in a subsample of 23 patients, brain magnetic resonance imaging were available. Patients were labelled FAST or SLOW depending on the Mini-Mental State Examination (MMSE) points lost per year (FAST if more than 3 points). We adopted single logistic regression models to search for independent predictors of FAST progression., Results: At baseline no differences were found between FAST and SLOW subgroups in demographics, MMSE scores, vascular burden and medial temporal lobe atrophy measurements. Higher plasma NfL concentrations and worse scores at semantic verbal fluency (SVF) and clock drawing test (CDT) were independent predictors of FAST decline, after controlling for age, education, sex and baseline disease severity stage. The regression model combining all the predictors correctly classified 80% of patients overall. The risk of FAST decline was 81.2% if all the three predictors were abnormal (i.e., SVF ≤21.5, CDT ≤5.5, NfL ≥22.19)., Conclusions: An easily applicable algorithm, including plasma NfL measurement and two neuropsychological tests worldwide adopted in clinical practice (SVF and CDT), may allow clinicians to reliably stratify AD patients in relation to the risk of fast cognitive decline., (© 2021 European Academy of Neurology.)

Directed, intentional imagination is pivotal for self-regulation in the form of escapism and therapies for a wide variety of mental health conditions, such anxiety and stress disorders, as well as phobias. Clinical application in particular benefits from increasing our understanding of imagination, as well as non-invasive means of influencing it. To investigate imagination, this study draws from the prior observation that music can influence the imagined content during non-directed mind-wandering, as well as the finding that relative orientation within time and space is retained in imagination. One hundred participants performed a directed imagination task that required watching a video of a figure travelling towards a barely visible landmark, and then closing their eyes and imagining a continuation of the journey. During each imagined journey, participants either listened to music or silence. After the imagined journeys, participants reported vividness, the imagined time passed and distance travelled, as well as the imagined content. Bayesian mixed effects models reveal strong evidence that vividness, sentiment, as well imagined time passed and distances travelled, are influenced by the music, and show that aspects of these effects can be modelled through features such as tempo. The results highlight music's potential to support therapies such as Exposure Therapy and Imagery Rescripting, which deploy directed imagination as a clinical tool., (© 2021. The Author(s).)

Objective: We evaluated the value of resting-state EEG source biomarkers to characterize mild cognitive impairment (MCI) subjects with an Alzheimer's disease (AD)-like cerebrospinal fluid (CSF) profile and to track neurodegeneration throughout the AD continuum. We further applied a resting-state functional MRI (fMRI)-driven model of source reconstruction and tested its advantage in terms of AD diagnostic accuracy., Methods: Thirty-nine consecutive patients with AD dementia (ADD), 86 amnestic MCI, and 33 healthy subjects enter the EEG study. All ADD subjects, 37 out of 86 MCI patients and a distinct group of 53 healthy controls further entered the fMRI study. MCI subjects were divided according to the CSF phosphorylated tau/β amyloid-42 ratio (MCIpos: ≥ 0.13, MCIneg: < 0.13). Using Exact low-resolution brain electromagnetic tomography (eLORETA), EEG lobar current densities were estimated at fixed frequencies and analyzed. To combine the two imaging techniques, networks mostly affected by AD pathology were identified using Independent Component Analysis applied to fMRI data of ADD subjects. Current density EEG analysis within ICA-based networks at selected frequency bands was performed. Afterwards, graph analysis was applied to EEG and fMRI data at ICA-based network level., Results: ADD patients showed a widespread slowing of spectral density. At a lobar level, MCIpos subjects showed a widespread higher theta density than MCIneg and healthy subjects; a lower beta2 density than healthy subjects was also found in parietal and occipital lobes. Evaluating EEG sources within the ICA-based networks, alpha2 band distinguished MCIpos from MCIneg, ADD and healthy subjects with good accuracy. Graph analysis on EEG data showed an alteration of connectome configuration at theta frequency in ADD and MCIpos patients and a progressive disruption of connectivity at alpha2 frequency throughout the AD continuum., Conclusions: Theta frequency is the earliest and most sensitive EEG marker of AD pathology. Furthermore, EEG/fMRI integration highlighted the role of alpha2 band as potential neurodegeneration biomarker., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To know whether mild cognitive impairment (MCI) patients will develop Alzheimer's disease (AD) dementia in very short time or remain stable is of crucial importance, also considering new experimental drugs usually tested within very short time frames. Here we combined cerebrospinal fluid (CSF) AD biomarkers and a neurodegeneration marker such as brain FDG-PET to define an objective algorithm, suitable not only to reliably detect MCI converters to AD dementia but also to predict timing of conversion., Methods: We included 77 consecutive MCI patients with neurological/neuropsychological assessment, brain 18F-FDG-PET and CSF analysis available at diagnosis and a neuropsychological/neurological evaluation every 6 months for a medium- to a long-term follow-up (at least 2 and up to 8 years). Binomial logistic regression models and Kaplan-Meier survival analyses were performed to determine the best biomarker (or combination of biomarkers) in detecting MCI converters to AD dementia and then, among the converters, those who converted in short time frames., Results: Thirty-five out of 77 MCI patients (45%) converted to AD dementia, with an average conversion time since MCI diagnosis of 26.07 months. CSF p-tau/Aβ42 was the most accurate predictor of conversion from MCI to AD dementia (82.9% sensitivity; 90% specificity). CSF p-tau/Aβ42 and FDG-PET-positive MCIs converted to AD dementia significantly earlier than the CSF-positive-only MCIs (median conversion time, 17.1 vs 31.3 months)., Conclusions: CSF p-tau/Aβ42 ratio and brain FDG-PET may predict both occurrence and timing of MCI conversion to full-blown AD dementia. MCI patients with both biomarkers suggestive for AD will likely develop an AD dementia shortly, thus representing the ideal target for any new experimental drug requiring short periods to be tested for.

Expression of CD133 and ABCB5 is associated with tumor aggressiveness, but evidence in papillary thyroid cancer (PTC) is lacking. We correlated CD133 and ABCB5 expression with pathological characteristics and factors of worse prognosis in PTC. Samples of 119 PTCs and 40 controls (goiters) were distributed in 8 tissue microarray blocks and evaluated with immunohistochemistry using anti-CD133 and anti-ABCB5 antibodies. The expression of each marker alone and combined was analyzed against pathological characteristics and factors of worse prognosis in PTC. Expression of CD133 alone (19 tumors, 16.0%) was more frequent in patients with versus without lymph node metastases (P=0.024). Expression of ABCB5 alone (n=95, 83.3%) was associated with larger tumor size (P=0.045). CD133-ABCB5 coexpression was not associated with pathological characteristics or factors of worse prognosis in PTC.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a potentially fatal autoimmune disease, characterized by autoantibody-mediated neurotransmission impairment in multiple brain locations. The course of this condition often comprises altered mental status, autonomic dysfunctions, refractory seizures and hyperkinetic movement disorders. Available disease-modifying therapies include corticosteroids, i.v. immunoglobulins, plasma exchange, rituximab and cyclophosphamide. In a subgroup of patients not responding to B-cell depletion, bortezomib, a proteasome inhibitor, has shown promising evidence of efficacy. The time course of recovery from acute phase may be very slow (weeks/months), and only few data are available in literature about the concurrent management of encephalitis-associated movement disorders. We report a case of severe anti-NMDAR encephalitis in a 29-year-old woman, not responsive to first- and second-line treatments, with persistent involuntary motor manifestations. Starting three months after symptom onset, four cycles of bortezomib have been administered; subsequently we observed a progressive improvement of neurological status. Meanwhile, motor manifestations were controlled after the administration of tramadol, a non-competitive NMDA receptor antagonist.

Background: The incoming disease-modifying therapies against Alzheimer's disease (AD) require reliable diagnostic markers to correctly enroll patients all over the world. CSF AD biomarkers, namely amyloid-β 42 (Aβ42), total tau (t-tau), and tau phosphorylated at threonine 181 (p-tau181), showed good diagnostic accuracy in detecting AD pathology, but their real usefulness in daily clinical practice is still a matter of debate. Therefore, further validation in complex clinical settings, that is patients with different types of dementia, is needed to uphold their future worldwide adoption., Methods: We measured CSF AD biomarkers' concentrations in a sample of 526 patients with a clinical diagnosis of dementia (277 with AD and 249 with Other Type of Dementia, OTD). Brain FDG-PET was also considered in a subsample of 54 patients with a mismatch between the clinical diagnosis and the CSF findings., Results: A p-tau181/Aβ42 ratio higher than 0.13 showed the best diagnostic performance in differentiating AD from OTD (86% accuracy index, 74% sensitivity, 81% specificity). In cases with a mismatch between clinical diagnosis and CSF findings, brain FDG-PET partially agreed with the p-tau181/Aβ42 ratio, thus determining an increase in CSF accuracy., Conclusion: The p-tau181/Aβ42 ratio alone might reliably detect AD pathology in heterogeneous samples of patients suffering from different types of dementia. It might constitute a simple, cost-effective and reproducible in vivo proxy of AD suitable to be adopted worldwide not only in daily clinical practice but also in future experimental trials, to avoid the enrolment of misdiagnosed AD patients., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Severe cognitive dysfunction is a frequent feature of multiple sclerosis (MS), normally associated with later stages of the disease in adult population. Nevertheless, progressive cognitive and neuropsychiatric disturbances might rarely be the presenting and predominant symptom. In order to better characterize this peculiar phenotype of MS, we report on the case of a 38-year-old man who referred to our hospital with the suspect of hereditary leukodystrophy after 5 years of behavioral and mood abnormalities, global cognitive dysfunction, clumsiness, and very mild pyramidal and cerebellar signs. Brain and spinal magnetic resonance imaging (MRI) combined with cerebrospinal fluid (CSF) analysis prompted the diagnosis of MS.

Co-existence of Alzheimer's disease (AD) in normal pressure hydrocephalus (NPH) is a frequent finding, thus a common pathophysiological basis between AD and NPH has been postulated. We measured CSF amyloid-β 42 (Aβ42), total tau (t-tau), and phosphorylated tau (p-tau) concentrations in a sample of 294 patients with different types of dementia and 32 subjects without dementia. We then compared scores on neuropsychological tests of NPH patients with pathological and normal CSF Aβ42 values. Aβ42 levels were significantly lower in NPH than in control patients, with no significant differences between AD and NPH. On the contrary, t-tau and p-tau levels were significantly lower in NPH than in AD, with no differences between NPH and controls. NPH patients with pathological Aβ42 levels did not perform worse than NPH patients with normal Aβ42 levels in any cognitive domains. Our data seem to support the hypothesis of amyloid accumulation in brains of NPH patients. Nevertheless, amyloid does not seem to play a pathogenetic role in the development of cognitive deficits in NPH.

Background: Correctly diagnosing Alzheimer's disease (AD) in prodromal phases would allow the adoption of experimental therapeutic strategies that could selectively interrupt the pathogenetic process before neuronal damage becomes irreversible. Therefore, great efforts have been aimed at finding early reliable disease markers., Objective: The aim of this study was to identify a simple, cost effective, and reliable diagnostic algorithm to predict conversion from mild cognitive impairment (MCI) to AD., Methods: 96 consecutive MCI patients admitted to the Neurology department of San Raffaele Hospital in Milan between January 2009 and January 2015 were included. All patients underwent neuropsychological assessment and lumbar puncture with CSF analysis of amyloid-β 42 (Aβ42), total tau (t-tau), and phosphorylated tau (p-tau) levels. Each patient underwent clinical and neuropsychological follow-up, in order to identify a possible progression from MCI to AD. The mean follow up time was 36.73 months., Results: 37 out of 96 MCI converted to AD during follow up. CSF analysis and neuropsychological assessment reliably detected MCI patients who developed AD. In a subsample of 43 subjects, a Composite Cognitive Score (CCS) was calculated including episodic memory, executive function, and verbal fluency tests. Combining together CSF biomarkers and CCS increased the accuracy of the single predictors, correctly classifying 86% of patients with a specificity of 96% and a Positive Predictive Value of 93%., Discussion: Even if preliminary, our data seem to suggest that CSF analysis and neuropsychological assessment could detect MCI patients who will convert to AD with high confidence. Their relative low cost and availability could make them worldwide essential tools in future clinical trials.

The study evaluated emissions from two incinerator plants and occupational exposure of workers during a six-year monitoring period (2004-2009). Chemical and microbiological analyses were performed by collecting environmental and staff individual air samples. Inspirable and respirable particulate and metals were measured in both environmental and staff samples; concentrations of Volatile Organic Compounds and the presence of microorganisms were investigated only in environmental samples. The concentrations of all organic and inorganic compounds investigated were very low and always below the Italian legal limits and the threshold limits recommended by the American Conference of Governmental Industrial Hygienists. In addition, microbial contamination was generally low in all the working areas considered. Study results revealed a good quality of air in the incineration plants and no apparent risk situation for the workers.

Fifty seven samples of Mytilus galloprovincialis (Lamarck, 1819) collected along the breakwater barriers of Fano (station 1) and Pesaro (station 2), Adriatic Sea, Marche Region, central Italy, were analyzed by atomic absorption spectrometry and Cd, Cu, Pb and Zn concentrations in the soft tissues were measured. The aims of this work were the statistical analysis of Cd-weight, Cu-weight, Pb-weight, Zn-weight relationships, and the building of a tendency function that allows assessing with a good approximation the concentrations of a metal in different weight organisms. In Mytilus galloprovincialis the content of Cd proportionally grew with the weight and therefore its concentration was independent from this factor; while the concentration of Pb decreased as the weight increased. In both cases the accuracy of multiple regression models improved considering the variable 'site', while the same approach appeared not reliable for Cu and Zn, that were two essential metals. Our results showed that a tendency function was reliable, solid and able to predict to a very satisfying extent the concentration of non-physiological metals, like Cd and Pb; while it did not show a good approximation with real Cu and Zn contents.

Asbestos reclamation works were carried out at a disused industrial plant (157,000 m(2)) in Bagnoli, a high population density area of Naples. The case-study here presented recommends a new reclamation procedure that is not usually provided for by current international standards. To this purpose, a specific innovative cleaning machine (Safecar) was built in order to control the reclamation procedures also in non-confined areas. An accurate identification was planned and worked out of the various types of materials (10,111 t) present within the area, and this allowed a thorough mapping of the site to be decontaminated. Besides these reclamation activities, which were carried out in both confined and open sites, each material was cleaned, collected and encapsulated following diversified procedures, according to their characteristics. Moreover, the evaluation of airborne asbestos fibre concentrations, both within and outside the decontaminated area, assured a strict respect of environmental safety level.

The faecal contamination indicators (total coliforms, faecal coliforms, Escherichia coli, enterococci) and the genera Salmonella, Vibrio, Aeromonas were investigated in water samples used for irrigation. During 4 months, 52 samples were taken. The methods used were: multiple tube fermentation method for faecal contamination indicators and membrane filtration techniques for salmonella, aeromonas and vibrio. Two samples were positive for Salmonella spp., fourteen for Aeromonas spp. and no samples for Vibrio spp. No correlation was found between aeromonas and the indicators of faecal contamination. Regarding Aeromonas spp., 21.6% of the strains were adhesive and 12.6% cytotoxic: this confirms the possible role of aeromonas in human pathologies. These results are important to determine the quality of irrigation water in relation to human health. In fact, the spray or sprinkler irrigation produces bioaerosol, which can contaminate the crops that are likely to be eaten uncooked. In addition, the flood or furrow irrigation represents a risk to field workers.

Marine organisms were evaluated as possible biomonitors of heavy metal contamination in marine coastal areas. Concentrations of Cd, Cr, Cu, Pb, and Zn were measured in the green algae Ulva lactuca L., the brown algae Padina pavonica (L.) Thivy, the bivalve mollusc Mytilus galloprovincialis Lamarck, and the two gastropod molluscs Monodonta turbinata Born and Patella cerulea L. collected at six coastal stations in the area of the Gulf of Gaeta (Tyrrhenian Sea, central Italy). The coastal area of the Regional Park of Gianola and Monte di Scauri (a "Protected Sea Park" area) was chosen as a control site. Seawater samples were also collected in each site to assess soluble and total metal concentrations and to gain additional information on both the environmental conditions of the area and possible bioaccumulation patterns. Metal concentrations detected in algae and molluscs did not show significant differences among all stations studied. Moreover, statistical analyses (ANOVA, multiple comparison tests, cluster analysis) showed that the Sea Park station was not significantly different from the others. The hypothesis that the Protected Sea Park would be cleaner than the others must therefore be reconsidered. Data from this study were also compared with those previously obtained from uncontaminated sites in the Sicilian Sea, Italy. The results show clearly differences between these two marine ecosystems. The species examined showed great accumulations of metals, with concentration factors (CFs) higher than 10,000 with respect to the concentrations (soluble fractions) in marine waters. Metal concentrations recorded in this area may be used for background levels for intraspecific comparison within the Tyrrhenian area, a body of water about which information is still very scarce.

Occupational exposure to polycyclic aromatic hydrocarbons (PAHs) has been demonstrated in many industrial sectors. However, up to date there are few studies in the literature on PAH exposure in thermoelectric power plants. The study was aimed at the evaluation of personal exposure to PAHs in workers of a power plant fueled with heavy oil. Exposure to polycyclic aromatic hydrocarbons (PAHs) and to benzene, toluene and xylenes (BTX) was evaluated on power plant workers exposed to heavy fuel oil; the control group consisted of office workers of the same power plant. Altogether 39 subjects were studied, for a total of 84 days of monitoring. Personal environmental exposure, cutaneous exposure and urinary concentrations of 1-hydroxypyrene (1-OHP), trans,trans-muconic acid (TTMA) and nicotine were measured. Personal environmental exposure to PAHs was very low; only maintenance workers showed exposure to total carcinogenic PAHs significantly higher than controls (median levels 3.05 and 0.88 ng/m3 respectively). All workers showed very low levels of dermal exposure to PAHs (less than 1 ng). The median 1-OHP urinary concentrations were 0.16, 0.11 and 0.08 mumol/mol creatinine in the groups of exposed workers and 0.08 mumol/mol creatinine in the control group. Neither the exposed workers nor the controls showed a significant increase in 1-OHP urinary concentrations across the shift. The regression analysis showed a significant effect of cigarette smoking on urinary 1-OHP, while no association was observed between occupational exposure and diet. Personal environmental exposure levels to BTX were very low. TTMA urinary concentrations of the exposed subjects were similar to those of the controls. No significant increase in the TTMA urinary concentrations was observed across the shift and, as expected, smokers showed higher values than non-smokers. The study did not show a measurable intake of PAHs and BTX in power plant workers that could be ascribed to occupational exposure, thus confirming the efficacy of the protective measures in force.

Often as part of environmental impact studies and, above all, to obtain authorisations in accordance with prescriptions from the Ministry for the Environment (Italy), surveys and controls that use biological indicators are required. This is because such indicators are valid instruments for evaluating the quality of the air ensuing from the subject (often an industrial plant) of the Environmental Impact Assessment (EIA). In this context, this paper aims to analyse some of the theoretical aspects of biological monitoring and to provide a progress report on the use of lichens as bioindicators of air quality, with a particular eye to the situation in Italy. The object of this paper is that of pointing out the most important lines in the current state of knowledge in this field, evaluating the methodological applications and their advantages/disadvantages with respect to traditional surveying methods.

This paper describes a system for electronic medical record (EMR) we have developed for use in our health care institution, mainly dealing with diagnosis and treatment of cardiovascular pathologies. This activity is part of the project SPERIGEST, supported by Health Ministry of Italy, for the management of health care delivery, as concerns both clinical and administrative aspects. A networked computer-based information system was realized to integrate the different heterogeneous sources of patient information. Both clinical and administrative patient relevant data are provided from the various systems and stored into a central database. The EMR system was designed using World Wide Web (WWW) technology (Java, HTML). The system is currently under clinical evaluation.

The aim of the study was to ascertain whether polycyclic aromatic hydrocarbons (PAHs) especially 3,4-benzo(a)pyrene, could be eluted from coal dust that comes into contact with biological fluids or crosses the skin barrier. A fine-grained coal dust with known PAH content was placed into contact with homogenized pig lung or human gastric juices, and also applied to monkey skin, using the cutaneous window method. The results demonstrate that, in the in vitro systems used, PAHs contained in coal dust are not eluted by lung homogenate or gastric juices, nor are they capable of crossing the skin barrier. These results justify and support the interpretation given to the results of experimental carcinogenicity studies on coal dust which never succeeded in demonstrating a higher incidence of cancer, particularly lung cancer, in treated animals.

The authors describe a case of undifferentiated rhabdomyosarcoma from unknown primary site, presenting as an acute hematologic malignancy with generalized lymphadenopathy, extensive bone marrow involvement and clinical and laboratory features of disseminated intravascular coagulation. Such a peculiar behaviour is known for rhabdomyosarcoma but is rare and can be a serious diagnostic problem for the clinician and the pathologist. The importance of a large spectrum immunohistochemistry as first diagnostic approach to any undifferentiated small-cell malignant tumor is stressed, together with the knowledge of the different immunoreactivity patterns. Desmin, MS-actin and myoglobin are the most reliable markers of this type of myogenic sarcoma.

The Authors describe a case of intranodal myofibroblastoma presenting in the submandibular region as a firm, indolent and freely mobile rounded nodule of about 3 cm. in diameter. The nature of this uncommon benign lesion is discussed. The observed histological features are partly different from the cases originally described. A proliferation of moderately pleomorphic spindle cells, which are vimentin and muscle specific actin positive, occupies a large part of a lymph node, sharply separated from the normal tissue. The so called "amianthoid fibres" are however absent and the inflammatory cells are almost exclusively eosinophils, mainly localized at the border between the lesion and the residual lymph node. Some spindle cells also show an unexplained positivity for the S-100 protein. In addition, extranodal extension of inflammation with few spindle cells is present. Such a complex picture has many features in common with the inflammatory pseudotumor of lymph node, another benign cause of lymphadenopathy. For this reason, the Authors suggest the possibility that myofibroblastoma is not a true neoplasm, but, together with the inflammatory pseudotumor, a peculiar type or a different stage of an abnormal lymph node reactivity.

Thirty-six consecutive patients with idiopathic haemochromatosis (IH) were studied by electrocardiography (ECG), polygraphy, M-mode and 2-D echocardiography and Doppler-echocardiography. No significant correlations were found between ECG, PEP/LVET ratio and echocardiographic measurements. Left ventricular (LV) enlargement with impaired LV systolic function was present only in three patients (5.5%), of whom two died during iron-depleting therapy because of cardiovascular complications. Compared with controls, echocardiographic abnormalities were significantly more frequent and marked in subjects with higher iron overload than in those in whom it was lower. Ten patients were studied before and after iron depletion, nine of whom had only mild echocardiographic abnormalities at baseline examination. Significant reduction of end-diastolic thickness of the interventricular septum and LV mass (P less than 0.01 and less than 0.02 respectively) was observed. Also the end-diastolic thickness of the LV posterior wall and the end-systolic diameter of the left atrium reduced although not to a significant degree. The increased thickness of ventricular walls without impairment of LV systolic function is probably the first and still reversible cardiac alteration due to iron deposition in the myocardium. Later, with increasing iron overload, LV function becomes impaired and dilated cardiomyopathy develops. Early diagnosis and treatment of IH cardiopathy is needed before irreversible cardiac damage occurs.

A new method for the determination of urinary lead by means of the emission spectroscopy is described. The sample is concentrated by lyophilization and the homogeneous dust obtained is analysed using the "double arc" method. The matrix effects and the source unstability are compensated by the use of the internal standard. The influence of the volatilization of the elements of the analytical pairs are studied and the pair thallium-lead is selected. The method is reproducible and the detection limit is 5 microgram/l of urinary lead.

The paper reviews the problems involved in sampling and analysis of pollutants in working environments. Special attention is given to the practical consequences of the particular working conditions of to-day, which are characterized by low levels of environmental pollution but are at the same time subject to the presence of mixtures of chemical substances. There is no doubt that the time has come to attempt to reach the greatest possible consensus on these problems (e.g., analytical procedures for complex mixtures). Guidelines and procedures are indicated for the control of indoor pollution and indoor air quality limits are proposed both for long-term (ALTER) and short-term (ASTER) exposures.