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BACKGROUND: Cognitive impairment is a frequent and disabling feature of Parkinson's disease. Identifying the factors able to predict cognitive worsening since the early stage may improve disease management. The objective of this study was to define the best predictors of future cognitive worsening in a group of patients with newly diagnosed PD and to propose cutoff values potentially useful at the individual level. METHODS: Fifty-four consecutive drug-naive patients with de novo PD were prospectively evaluated by clinical and neuropsychological assessment, resting EEG, and 123 I-FP-CIT-SPECT and clinically classified into mainly motor, diffuse/malignant, and intermediate PD subtypes; they were then followed up for an average of 5 years. Cognitive outcome was defined by identifying cognitively stable or worsened patients. RESULTS: Step-wise logistic regression selected the posterior qEEG mean frequency and 123 I-FP-CIT-SPECT uptake at caudate level (P < 0.0001). The posterior qEEG mean frequency (cut point, 8.3 Hz) and the caudate 123 I-FP-CIT-SPECT uptake (cut point, 2.3, specific to nondisplaceable binding ratio) achieved 82% and 80% of accuracy, respectively, in predicting cognitive outcome. Survival analysis showed decreasing expected time to cognitive worsening associated with scores below the established thresholds for qEEG and 123 I-FP-CIT-SPECT and with the presence of a malignant clinical phenotype. CONCLUSIONS: Resting EEG and 123 I-FP-CIT-SPECT are good predictors of future cognitive worsening, in de novo drug-naive PD patients. Wherever available, these biomarkers could add valuable prognostic information to classification into different clinical phenotypes. © 2017 International Parkinson and Movement Disorder Society.

According to the new research criteria for the diagnosis of Alzheimer's disease, episodic memory impairment, not significantly improved by cueing, is the core neuropsychological marker, even at a pre-dementia stage. The FCSRT assesses verbal learning and memory using semantic cues and is widely used in Europe. Standardization values for the Italian population are available for the colored picture version, but not for the 16-item printed word version. In this study, we present age- and education-adjusted normative data for FCSRT-16 obtained using linear regression techniques and generalized linear model, and critical values for classifying sub-test performance into equivalent scores. Six scores were derived from the performance of 194 normal subjects (MMSE score, range 27-30, mean 29.5 ± 0.5) divided per decade (from 20 to 90), per gender and per level of education (4 levels: 3-5, 6-8, 9-13, >13 years): immediate free recall (IFR), immediate total recall (ITR), recognition phase (RP), delayed free recall (DFR), delayed total recall (DTR), Index of Sensitivity of Cueing (ISC), number of intrusions. This study confirms the effect of age and education, but not of gender on immediate and delayed free and cued recall. The Italian version of the FCSRT-16 can be useful for both clinical and research purposes.

PURPOSE: The role of mesocortical dopaminergic pathways in the cognitive function of patients with early Parkinson's disease (PD) needs to be further clarified. METHODS: The study groups comprised 15 drug-naive patients with de novo PD and 10 patients with essential tremor (controls) who underwent 18F-DOPA PET (static acquisition, normalization on mean cerebellar counts) and an extended neuropsychological test battery. Factor analysis with varimax rotation was applied to the neuropsychological test scores, to yield five factors from 16 original scores, which explained 82 % of the total variance. Correlations between cognitive factors and 18F-DOPA uptake were assessed with SPM8, taking age and gender as nuisance variables. RESULTS: 18F-DOPA uptake was significantly lower in PD patients than in controls in the bilateral striatum, mainly in the more affected (right) hemisphere, and in a small right temporal region. Significant positive correlations were found only in PD patients between the executive factor and 18F-DOPA uptake in the bilateral anterior cingulate cortex (ACC) and the middle frontal gyrus, between the verbal fluency factor and 18F-DOPA uptake in left BA 46 and the bilateral striatum, and between the visuospatial factor and 18F-DOPA uptake in the left ACC and bilateral striatum. No correlations were found between 18F-DOPA uptake and either the verbal memory factor or the abstraction-working memory factor. CONCLUSION: These data clarify the role of the mesocortical dopaminergic pathways in cognitive function in early PD, highlighting the medial frontal lobe, anterior cingulate, and left BA 46 as the main sites of cortical correlation with executive and language functions.

Background: Resilience is a complex personality characteristic of people facing a significant change, adversity, distress, acute or chronic disease. The Wagnild and Young Resilience Scale is an appropriate instrument to study resilience and has been already validated in the Italian young-adult population. Objective: To verify psychometric properties of the Italian version of the RS scale in adults and elderly healthy subjects. Design: The participants filled out RS questionnaire; statistical analysis was performed to evaluate psychometric properties of the scale. Setting: University of Genoa: courses reserved for elderly people and Clinical Neurology outpatients' department. Participants: 178 adults and elderly healthy subjects. Measurement: The Italian version of RS scale and three associate questionnaire (General Health Questionnaire, Ego-Resilience Scale, Beck Depression Inventory) were used to assess concurrent validity of RS, its reliability, stability, internal consistency and concurrent validity. Results: Time stability was assessed in a sub-sample of 48 subjects (Mean age = 68.89 yr, SD 7.54) by test-retest correlation (r=0.80). RS reliability was evaluated in the whole sample of 178 subjects (Mean age = 63.92 yr, SD 14.6) with an RS mean score of 138.43 (SD 14.6). Internal consistency was evaluated by Cronbach alpha (?=0.86). Concurrent validity was assessed by correlation with General Health Questionnaire (r=-0.45), Ego-Resilience Scale (r=0.59) and Beck Depression Inventory (r=-0.31). Principal component analysis resulted into six components, labelled according to the best association with the five components hypothesized by Wagnild and Young (i.e.: meaningfulness, self-reliance, perseverance, existential aloneness, equanimity a and b). Conclusion: Our data indicate that the Italian version of the RS scale is a reliable tool in the adults and elderly subjects in order to promote interventions and stress-management to improve resilience and facilitate successful aging.