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The distribution of the Glu298Asp polymorphism in NOS3 gene was determined in 405 Italian patients with “probable” Alzheimer's disease (AD) compared with 253 age-matched controls. Total plasma homocysteine (tHcy) levels were evaluated in 97 patients and 23 controls, and were correlated with the Glu298Asp genotype. A significantly increased frequency of the Glu/Glu genotype in late onset AD (LOAD) patients was found. tHcy levels were significantly increased in patients compared with controls and, notably, higher in LOAD than in early onset AD (EOAD). Stratifying by the Glu298Asp genotype, a trend toward an increase of tHcy was present in Glu/Glu homozygous. This wild type genotype seems to be associated with LOAD. tHcy levels are significantly increased in AD compared with controls and, moreover, higher in LOAD than in EOAD, possibly in correlation with the microvascular disease occurring with aging. Besides, a contribution of the Glu/Glu genotype in increasing tHcy levels has been observed.

Objectives s To evaluate the efficacy of two different procedures of individual cognitive training in mild to moderate Alzheimer's Disease (AD). Material and methods - Twenty-two AD patients entered the study. We compared stimulation of procedural memory (group 1) with training of partially spared cognitive functions (group 2). Assessment included: neuropsychological tests, scales, and the Functional Living Skills Assessment (FLSA), a standardized battery built to directly evaluate patients' performance in everyday life. Results We observed a significant improvement for both groups after training in FLSA total score (P = 0.005) and subscales. For group 1, we also found a slightly improved performance in two tests: Attentional Matrices (P = 0.041), and Verbal Fluency for Letters (P = 0.059). After 3 months, patients' results showed a tendency to regress to the pre-training level. Conclusion Both AD groups showed a substantial improvement after training in a direct performance measure of everyday functioning. However, results at neuropsychological tests suggest that training activities of daily living (supported by procedural memory) may be more effective than stimulating residual' cognitive functions.

An impairment at tasks sensitive to frontal lobe damage has been repeatedly reported in Parkinson's disease, but the exact nature of these deficits has not yet been clarified. Similarly, deficits of visuo-spatial functions have been frequently observed, but it is still debated whether verbal and visuo-spatial memory can be differentially affected. In this study we have compared the performance of 20 mild Parkinson's disease patients (I-II Hoehn and Yahr stage) and 18 matched normal controls, at tasks assessing frontal functions and explicit memory. We detected a selective deficit in set shifting and maintaining, without impairment in categorization and set formation. The lack of a selective increase in perseverative errors might indicate that perseverations either measure something different from set shifting or that they do not represent an index sensitive enough to set shifting impairment. Parkinson's disease patients were also significantly impaired at Raven's Progressive Matrices, a task assessing both frontal and visuo-spatial aspects. However, they did not show any differential impairment of visuo-spatial memory. Indeed, despite a trend of lower performance in visuo-spatial learning, memory performance of Parkinson's disease patients was significantly different from that of controls only at a free recall test which involved both verbal and visuo-spatial memory. We suggest the exploration of set shifting and maintaining to detect 'frontal' deficits in mild Parkinson's disease. We argue that Raven's Progressive Matrices is a valuable task for detecting subclinical cognitive deficits in Parkinson's disease, even if it does not show a specific profile of impairment in these patients. According to our results, a differential evaluation of verbal vs. visuo-spatial memory is not necessary in clinical practice, whilst free recall confirms its usefulness to detect subclinical impairments of memory functions.

We report a patient who, after a left parieto-occipital lesion, showed alexia and selective dysgraphia for uppercase letters. He showed preserved oral spelling, associated with handwriting impairment in all written production; spontaneous writing, writing to dictation, real words, pseudowords, and single letters were affected. The great majority of errors were well-formed letter substitutions: most of them were located on the first position of each word, which the patient always wrote in uppercase (as he used to do before his illness). The patient also showed a complete inability to access the visual representation of letters. As demonstrated by a stroke segmentation analysis, letter substitutions followed a rule of graphomotor similarity. We propose that the patient's impairment was at the stage where selection of the specific graphomotor pattern for each letter is made and that the apparent selective disruption of capital case was due to a greater stroke similarity among letters belonging to the same case. We conclude that a visual format is necessary neither for spelling nor for handwriting.

While the evaluation of patients with dementia must also address the possibility of treatable illnesses, recent studies found that reversible diseases are detected in only about 1% of dementia cases. Data on the frequency and evolution of potentially reversible dementias (PRD) in defined clinical settings can be useful in order to optimize diagnostic protocols, thus reducing over-investigation and waste of resources. We reviewed a series of 513 patients (mean age 69.3 +/- 4.2 years, mean education level 7.4 +/- 4.5 years, sex ratio M/F 217/296) referred to a memory clinic by their general practitioner, in order to identify PRD. All the subjects had undergone neurological and neuropsychological examination, and laboratory tests. Patients considered to be demented also underwent CT brain scan. 362 patients (70.6%) met the criteria for dementia. We identified 26 PRD cases (7.2% of dementia cases, 5.1% of the entire sample). In 13 patients (3.6% of dementia cases), a complete clinical and neuropsychological reversal of dementia was seen after treatment. In 5 of them (1.4%), a partial regression was obtained, while 8 showed no improvement. We conclude that potential and actual reversibility do not coincide, and that "true" reversibility is rare (even if not negligible) in clinical practice. Careful clinical history and examination appeared the most useful part of the evaluation to identify PRD. Standard blood tests and vitamin B12 assay were also useful, while CT scan detected PRD causes only in patients with evidence of neurological signs.

We correlated the clinical features of 78 patients with Guillain-Barré syndrome (GBS) or related variants, with the presence of serum antibodies to the gangliosides GM1, GM2, GD1a, GD1b and GQ1b in order to determine whether these antibodies may influence the clinical presentation or outcome of GBS. Sixty-three patients had typical GBS (81%), nine a pure motor form (11%), three a paraparetic form (4%), and three had Miller Fisher syndrome (MFS). IgG or IgM (or both) anti-ganglioside antibodies were found by ELISA in 37% of patients, including 36% with typical, 33% with pure motor and 100% with MFS. Beside the constant occurrence of anti-GQ1b antibodies in patients with MFS (P

Interest in frontal functions has progressively increased over recent years; however, despite this, there are only a few "frontal" tasks for which Italian normative data are available. The objective of this study was to obtain reference values for two frontal tests from a random sample of normal adults: the first (the Test of Classification and Recall of Pictures) has been shown to reveal selective impairment in patients with unilateral frontal excision; the second (the Odd-Man-Out Test) derives from tasks which have been used to evaluate frontal functions in animals and detect frontal impairment in Parkinson patients. We tested 100 normal subjects, aged 22 to 79 years, stratified by education according to the Italian school system. The correction grids for both tests are also presented. The usefulness of these tests is represented not only by their sensitivity to frontal impairment, but also by the possibility of dissociating the various cognitive aspects of frontal lobe dysfunction.

About 60% of patients complain of cutaneous allodynia during migraine episodes, often in the periorbitary region of the pain side. Pre-clinical studies have shown that the underlying mechanism is sensitisation of primary nociceptors and central trigeminovascular neurons and that patients have a lower pain threshold for mechanical stimulation compared to controls. The objective of this study was to determine the prevalence of allodynia during headache attacks in different forms of migraine. The subjects were 221 outpatients consecutively evaluated in the Headache Center of the L. Sacco Hospital in Milan: 114 had only attacks of migraine without aura (MO), 63 had also attacks with aura (MA) and 44 patients with chronic migraine with and without drug overuse (CM). Presence of head allodynia was investigated by a semistructured interview. Statistical analysis was performed by chi square test with Bonferroni correction for multiple comparisons. Forty-seven out of 114 MO patients (41.2%) complained of allodynia during headache episodes, 41 out of 63 MA patients (65.0%), and 29 out of 44 CM patients (65.9%). A higher frequency of allodynia in MA and CM with respect to MO patients was observed (p

We describe a patient with probable dementia with Lewy bodies (DLB) whose Parkinsonism worsened after administration of rivastigmine within the therapeutic dose range. Some extrapyramidal signs (EPS) then reversed to pre-treatment level after rivastigmine dose reduction. We draw attention to the need of EPS monitoring during titration of cholinesterase inhibitors in patients with DLB. This is the first report to our knowledge of iatrogenic worsening of Parkinsonism which was successfully managed by dose reduction.

Background: There is some impairment of the ability of patients with Alzheimer’s disease (AD) to perceive emotions, but this ability seems relatively preserved compared to the impairment of other cognitive domains. Few studies have focused on the link between emotional processing and other cognitive functions, such as memory or attention. Objective: This study was designed to investigate whether the emotional content of a text can influence memory in patients affected by AD and whether this effect is related to attentional processes as measured by event-related potentials (ERP). Methods: All subjects were administered neuropsychological tests and a logical memory test including emotional and nonemotional material. ERP were recorded during an attention task. Results: AD patients had better immediate recall of sad and, to a lesser extent, happy stories than of neutral stories. This difference also affected multiple choice recognition and identification (immediate and delayed) of emotional content. The amplitude of both P300 and mismatch negativity was significantly decreased in the group as a whole. There was no correlation between P300 parameters and performance on the memory tasks, whatever their emotional content. Conclusions: The results show relatively preserved emotional processing in patients with AD and suggest that the emotional content of a context can influence memory performance. We found no evidence that this effect is mediated by attention as measured by ERP.

PURPOSE: To evaluate differences between the retinal nerve fiber layer (RNFL) thickness and RNFL + ganglion cell layer (GCL) thickness in patients affected by Alzheimer's disease (AD) and healthy patients using spectral-domain optical coherence tomography (SD-OCT). METHODS: This was a case-control prospective study. Twenty-one AD patients and 21 healthy subjects underwent neurological examination, clock-drawing test (CDT), Mini Mental State Examination (MMSE), and comprehensive ophthalmic evaluation with visual acuity. SD-OCT examination was performed using Spectralis and RTVue-100. An RNFL thickness map was obtained using the Spectralis volume protocol with 19 lines on the 30° field centered on the macula. On each B-scan, the outer RNFL limit was manually set. Statistical analysis was performed to assess interoperator RNFL evaluation thickness. An RNFL+GCL thickness map was obtained using the RTVue-100 MM6 protocol. Maps were divided into the nine ETDRS subfields and each map value in every area was evaluated. A single eye from each patient was randomly chosen to perform the analysis. Differences between AD and healthy subjects were assessed. RESULTS: The two study groups were age and sex matched. MMSE results were 19.9 ± 3.1 and 27.9 ± 1.3, respectively (P < 0.001). There was good agreement in the manual delimitation of the RNFL layer. There was a significant difference in the thickness of both the RNFL and the RNFL+GCL in all examined fields. For example, in the inferior internal subfield, the RNFL thickness was 28.1 ± 3.1 μm for AD patients and 32.6 ± 3.8 μm for healthy subjects (P < 0.001). CONCLUSIONS: These results indicate that RNFL and RNFL+GCL thickness measurements are reduced in AD patients compared with healthy subjects. This finding may represent a useful element for the diagnosis and follow-up of this pathology.

Erratum to: Neurol Sci (2011) 32:1057–1062DOI 10.1007/s10072-011-0607-3In the published original article, section Materials, page1059, lines 28–29, the formula (IFR–ITR)/(IFR-36) hasbeen wrongly typeset.The correct sentence should read:(e) Index of Sensitivity of Cueing (ISC): (IFR–ITR)/(IFR-36) (range 0–1)