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Scopo: verificare l'efficacia di un programma riabilitativo cognitivo domiciliare in pazienti con malattia di Alzheimer, in termini di miglioramento sia delle performance cognitive-comportamentali che delle attività della vita quotidiana. Metodi: sono stati arruolati pazienti affetti da probabile AD; i pazienti e i familiari con buona compliance venivano arruolati nel 'gruppo riabilitativo'(GR), quelli senza tale compliance costituivano il 'gruppo di controllo' (GC). I soggetti al tempo basale (T0) sono stati sottoposti a test neuropsicologici (MMSE) ed a scale di daily -living (IADL) e comportamentali (NPI). I soggetti GR venivano addestrati con un familiare all'uso di un eserciziario per il training cognitivo domiciliare quotidiano. Dopo 12 settimane tutti i pazienti venivano sottoposti a MMSE , IADL, e NPI. Risultati:sono stati arruolati 10 soggetti in entrambi i gruppi con caratteristiche generali omogenee. Il confronto relativo alle medie dei parametri cognitivo-funzionali non hanno evidenziato differenze significative al tempo basale. Dopo il periodo di trattamento riabilitativo (T1) GR ha evidenziato , rispetto a GC, un miglioramento in MMSE e NPI e in GC un peggioramento di NPI. Conclusioni: l'intervento riabilitativo cognitivo domiciliare sembra influenzare in modo positivo le performance cognitive con una successiva ricaduta anche sul parametro comportamentale e di daily-living. il rilievo di una efficacia della riabilitazione cognitiva in AD ripropone l'importanza di affrontare in termini metodologici e strumentali controllati questo tipo di intervento., Aim. This clinical study aims at assessing the efficacy of a home cognitive rehabilitation program for Alzheimer Disease patients, evaluating the improvement in cognitive-behavioural performances and daily living activities. Methods. Patients who reported a good compliance to cognitive rehabilitation were assigned to the “rehabilitated group” (GR), and those patients with poor compliance were enrolled in the “control group” (GC). 10 patients were respectively enrolled in the GR and the GC. At the basal time (T0) all patients underwent a comprehensive neuropsychological assessment including psychometric tests (MMSE) as well as daily living (IADL) and behavioural (NPI) questionnaires. GR subjects were instructed to use an ad hoc designed exercise book for their daily home cognitive training, which needs the help of relatives. After 12 weeks (T1) all patients underwent re-evaluations. Results. Patients enrolled in the GR and the GC had homogeneous characteristics with respect to age, gender, education and disease duration. At baseline, the cognitive and functional parameters did not show any statistically significant difference between the two groups. After cognitive rehabilitation (T1) GR showed, in respect to GC, a significant statistical improvement in MMSE and IADL; the analysis pre-post rehabilitation showed an improvement in MMSE and NPI for GR and a worsening in NPI for GC. Conclusion. The home cognitive rehabilitation seems to have a positive influence on cognitive performances with an effective rebound on behaviour and daily living activities in Alzheimer disease patients. These findings need to be replicated in a larger randomized controlled trial.

to correlate cerebral histopathological and immunohistochemical changes in the neuroclinical features of the AIDS dementia complex(ADC), autopsy results of 28 ADC patients were related, in a retrospective analysis, to scores on a standardised neurological examination performed at neurological onset. from a histopathological point of view, the cases were classified as follows: 9 cases of HIV leucoencephalopathy (HIVL; diffuse myelin damage and rare microglial nodules), 7 cases of HIV encephalitis (HIVE; several microglial nodules and no myelin damage) and 12 cases of mixed HIVL and HIVE (HIVL-E). The groups differed significantly with respect to symptoms and CD4 count at neurological onset, survival and neurological impairment. Immunohistochemically, the interstitial component (p-24-positive cells scattered singly within the white matter) was significantly more prevalent in HIVL, and the micronodular component (P24-positive cells confined within microglial nodules) in HIVE. Neurological damage was worse in cases with a high prevalence of interstitial component or a low prevalence of micronodular component. HIVE, HIVL, and HIVL-E are distinct clinical forms of ADC. Neurological impairmente is related to white matter damage.