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Background and purpose: Clinical outcomes of multiple sclerosis (MS) patients affected by coronavirus disease 2019 (COVID-19) have been thoroughly investigated, but a further analysis on main signs and symptoms and their risk factors still needs attention. The objective of this study was to group together and describe based on similarity the most common signs and symptoms of COVID-19 in MS patients and identify all factors associated with their manifestation. Method: Logistic and linear regression models were run to recognize factors associated with each pooled group of symptoms and their total number. Results: From March 2020 to November 2021, data were collected from 1354 MS patients with confirmed infection of COVID-19. Ageusia and anosmia was less frequent in older people (odds ratio [OR] 0.98; p=0.005) and more in smoker patients (OR 1.39; p=0.049). Smoke was also associated with an incremental number of symptoms (OR 1.24; p=0.031), substance abuse (drugs or alcohol), conjunctivitis and rash (OR 5.20; p=0.042) and the presence of at least one comorbidity with shortness of breath, tachycardia or chest pain (OR 1.24; p=0.008). Some disease-modifying therapies were associated with greater frequencies of certain COVID-19 symptoms (association between anti-CD20 therapies and increment in the number of concomitant symptoms: OR 1.29; p=0.05). Differences in frequencies between the three waves were found for flu-like symptoms (G1, p=0.024), joint or muscle pain (G2, p=0.013) and ageusia and anosmia (G5, p < 0.001). All cases should be referred to variants up to Delta. Conclusion: Several factors along with the choice of specific therapeutic approaches might have a different impact on the occurrence of some COVID-19 symptoms.

Introduction: Dementia with Lewy bodies (DLB) may represent a diagnostic challenge, since its clinical picture overlaps with other dementia. Two toolkits have been developed to aid the clinician to diagnose DLB: the Lewy Body Composite Risk Score (LBCRS) and the Assessment Toolkit for DLB (AT-DLB). We aim to evaluate the reliability of these two questionnaires, and their ability to enhance the interpretation of the international consensus diagnostic criteria. Methods: LBCRS and AT-DLB were distributed to 135 Italian Neurological Centers for Cognitive Decline and Dementia (CDCDs), with the indication to administer them to all patients with dementia referred within the subsequent 3months. We asked to subsequently apply consensus criteria for DLB diagnosis, to validate the diagnostic accuracy of the two toolkits. Results: A total of 23 Centers joined the study; 1854 patients were enrolled. We found a prevalence of possible or probable DLB of 13% each (26% total), according to the consensus criteria. LBCRS toolkit showed good reliability, with a Cronbach alpha of 0.77, stable even after removing variables from the construct. AT-DLB toolkit Cronbach alpha was 0.52 and, after the subtraction of the "cognitive fluctuation" criterion, was only 0.31. Accuracy, sensitivity, and specificity were higher for LBCRS vs. AT-DLB. However, when simultaneously considered in the logistic models, AT-DLB showed a better performance (p

Altres ajuts: Additionally, this work was funded by the CIBERNED program (Program 1, Alzheimer Disease), FondoEuropeo de Desarrollo Regional (FEDER), Unión Europea, "Una manera de hacer Europa" and a "Marató TV3" grant (grant number: 201412.10). The cerebrospinal fluid (CSF) biomarkers amyloid-β 1-42 (Aβ), total and phosphorylated tau (t-tau, p-tau) are increasingly used to assist in the clinical diagnosis of Alzheimer's disease (AD). However, CSF biomarker levels can be affected by confounding factors. To investigate the association of white matter hyperintensities (WMHs) present in the brain with AD CSF biomarker levels. We included CSF biomarker and magnetic resonance imaging (MRI) data of 172 subjects (52 controls, 72 mild cognitive impairment (MCI), and 48 AD patients) from 9 European Memory Clinics. A computer aided detection system for standardized automated segmentation of WMHs was used on MRI scans to determine WMH volumes. Association of WMH volume with AD CSF biomarkers was determined using linear regression analysis. A small, negative association of CSF Aβ, but not p -tau and t -tau, levels with WMH volume was observed in the AD (r 2 = 0.084, p = 0.046), but not the MCI and control groups, which was slightly increased when including the distance of WMHs to the ventricles in the analysis (r 2 = 0.105, p = 0.025). Three global patterns of WMH distribution, either with 1) a low, 2) a peak close to the ventricles, or 3) a high, broadly-distributed WMH volume could be observed in brains of subjects in each diagnostic group. Despite an association of WMH volume with CSF Aβ levels in AD patients, the occurrence of WMHs is not accompanied by excess release of cellular proteins in the CSF, suggesting that WMHs are no major confounder for AD CSF biomarker assessment.

Background: The Smart Aging Serious Game (SASG) is an ecologically-based digital platform used in mild neurocognitive disorders. Considering the higher risk of developing dementia for mild cognitive impairment (MCI) and vascular cognitive impairment (VCI), their digital phenotyping is crucial. A new understanding of MCI and VCI aided by digital phenotyping with SASG will challenge current differential diagnosis and open the perspective of tailoring more personalized interventions. Objective: To confirm the validity of SASG in detecting MCI from healthy controls (HC) and to evaluate its diagnostic validity in differentiating between VCI and HC. Methods: 161 subjects (74 HC: 37 males, 75.47±2.66 mean age; 60 MCI: 26 males, 74.20±5.02; 27 VCI: 13 males, 74.22±3.43) underwent a SASG session and a neuropsychological assessment (Montreal Cognitive Assessment (MoCA), Free and Cued Selective Reminding Test, Trail Making Test). A multi-modal statistical approach was used: receiver operating characteristic (ROC) curves comparison, random forest (RF), and logistic regression (LR) analysis. Results: SASG well captured the specific cognitive profiles of MCI and VCI, in line with the standard neuropsychological measures. ROC analyses revealed high diagnostic sensitivity and specificity of SASG and MoCA (AUCs > 0.800) in detecting VCI versus HC and MCI versus HC conditions. An acceptable to excellent classification accuracy was found for MCI and VCI (HC versus VCI; RF: 90%, LR: 91%. HC versus MCI; RF: 75%; LR: 87%). Conclusion: SASG allows the early assessment of cognitive impairment through ecological tasks and potentially in a self-administered way. These features make this platform suitable for being considered a useful digital phenotyping tool, allowing a non-invasive and valid neuropsychological evaluation, with evident implications for future digital-health trails and rehabilitation.

Alzheimer’s disease (AD) is the most common neurodegenerative disease among the elderly with a progressive decline in cognitive function significantly affecting quality of life. Both the prevalence and emotional and financial burdens of AD on patients, their families, and society are predicted to grow significantly in the near future, due to a prolongation of the lifespan. Several lines of evidence suggest that modifications of risk-enhancing life styles and initiation of pharmacological and non-pharmacological treatments in the early stage of disease, although not able to modify its course, helps to maintain personal autonomy in daily activities and significantly reduces the total costs of disease management. Moreover, many clinical trials with potentially disease-modifying drugs are devoted to prodromal stages of AD. Thus, the identification of markers of conversion from prodromal form to clinically AD may be crucial for developing strategies of early interventions. The current available markers, including volumetric MRI, PET, and CSF analysis are expensive, poorly available in community health facilities, and relatively invasive. Taking into account its low cost, widespread availability and non-invasiveness, EEG would represent a candidate for tracking the prodromal phases of cognitive decline in routine clinical settings eventually in combination with other markers. After providing a short overview of the epidemiology and markers in AD, this review aimed to explore whether advanced analysis of EEG rhythms exploring brain function has sufficient specificity/sensitivity/accuracy to screen out the risk of conversion from Mild cognitive Impairment (MCI, a condition which is prodromal to AD in a high percentage of cases) to AD as a first-level screening method.

Alzheimer's disease (AD) is the most common neurodegenerative disease among the elderly with a progressive decline in cognitive function significantly affecting quality of life. Both the prevalence and emotional and financial burdens of AD on patients, their families, and society are predicted to grow significantly in the near future, due to a prolongation of the lifespan. Several lines of evidence suggest that modifications of risk-enhancing life styles and initiation of pharmacological and nonpharmacological treatments in the early stage of disease, although not able to modify its course, helps to maintain personal autonomy in daily activities and significantly reduces the total costs of disease management. Moreover, many clinical trials with potentially disease-modifying drugs are devoted to prodromal stages of AD. Thus, the identification of markers of conversion from prodromal form to clinically AD may be crucial for developing strategies of early interventions. The current available markers, including volumetric magnetic resonance imaging (MRI), positron emission tomography (PET), and cerebral spinal fluid (CSF) analysis are expensive, poorly available in community health facilities, and relatively invasive. Taking into account its low cost, widespread availability and non-invasiveness, electroencephalography (EEG) would represent a candidate for tracking the prodromal phases of cognitive decline in routine clinical settings eventually in combination with other markers. In this scenario, the present paper provides an overview of epidemiology, genetic risk factors, neuropsychological, fluid and neuroimaging biomarkers in AD and describes the potential role of EEG in AD investigation, trying in particular to point out whether advanced analysis of EEG rhythms exploring brain function has sufficient specificity/sensitiv ity/accuracy for the early diagnosis of AD. H2020 Marie S. Curie ITN-ETN project Turkish Academy of Sciences (TUBA), Turkey, The Young Scientists Award Programme (GEBIP) Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)

Macroscale white matter pathways are the infrastructure for large-scale communication in the human brain and a prerequisite for healthy brain function. Disruptions in the brain's connectivity architecture play an important role in many psychiatric and neurological brain disorders. Here we show that connections important for global communication and network integration are particularly vulnerable to brain alterations across multiple brain disorders. We report on a cross-disorder connectome study comprising in total 1,033 patients and 1,154 matched controls across 8 psychiatric and 4 neurological disorders. We extracted disorder connectome fingerprints for each of these 12 disorders and combined them into a 'cross-disorder disconnectivity involvement map' describing the level of cross-disorder involvement of each white matter pathway of the human brain network. Network analysis revealed connections central to global network communication and integration to display high disturbance across disorders, suggesting a general cross-disorder involvement and the importance of these pathways in normal function.

Introduction: Arterial Spin Labeling (ASL) is an MRI method that uses magnetically labeled endogenous water as a tracer for measuring cerebral perfusion in vivo1. The arterial water that is usually 'labeled' at a plane positioned at the base of the brain, perpendicular to the carotids. A post-labeling delay (PLD) is introduced prior to acquisition to allow labeled water to cross the vasculature and perfuse into the tissue1. Because of signal decay due to T1 relaxation, fast acquisition schemes are employed to ensure optimal SNR. Consequently, the spatial resolution of ASL is relatively low (~ 3 x 3 x 6 mm3). As such, the measured blood flow from a given voxel reflects a mixture of signals from gray matter (GM), white matter (WM), and CSF, a phenomenon known as partial voluming (PV)2. To correct for the confounding effects of PV in ASL imaging, an algorithm (PVC) has been developed and already used by several studies2,3. The algorithm is based on GM and WM volume data obtained from the segmentation of the T1w image2, and makes no further distinction between different compartments within the same tissue type. Here, we investigated the potential of PVC ASL to map blood perfusion in the extra-neurite compartment (e.g., soma, glial cells4) and the intra-neurite (comprised of axons and axon terminals4) within the same tissue, independently. We applied the PVC algorithm using compartmental data from a diffusion weighted imaging (DWI) model, referred to as NODDI4. The underlying hypothesis was that the blood flow in the extra- and intra-neurite compartments would vary with the PLD; a short PLD acquisition would increase the flow in the extra-neurite compartment compared to the long PLD for which there should be an increased flow in the intra-neurite compartment instead. Methods: Theory At any given voxel, the blood flow (fT) is given as: fT=VFIn•fIn+VFEn•fEn+VFIso•fIs where, VFIn, VFEn, VFIso represent respectively: the intra-neurite, extra-neurite, and non-tissue compartments obtained from NODDI4. By assuming that for each compartment blood flow is constant over a 'kernel', the equation can be re-written in vectorial form to reflect the flow at the voxel in the center of the kernel2, from which then each compartmental flow can be computed using linear regression as detailed in Asllani et al.2.. MRI protocol & image analysis T1w (MPRAGE), NODDI, and ASL MRI images were obtained on 4 healthy participants (mean age = 44.5 ± 7.4 y, 2 men) a Siemens 3T system. To test the hypothesis that a shorter PLD would increase the signal in the extra-neurite GM compartment, ASL was acquired with a short (200ms) and long PLD (1800ms). Only results from voxels with GM content > 80% are presented. Results: Fig.1 shows the raw images that were used by the PVC algorithm to extract the flow from each compartment within the GM. For the long-PLD acquisition, average CBF in the extra- and intra-neurite compartments was 76 ± 10 mL/100g*min and 59 ± 8 mL/100g*min, respectively. As hypothesized, for the short-PLD, the CBF signal was contained primarily in the extra-neurite department (118 ± 17 mL/100g*min) with the intra-neurite compartment flow being essentially zero (-0.9 ± 0.6 mL/100g*min). Results from one participant are shown in Fig.2. Supporting Image: Fig1.jpg ·Fig.1: ‘Raw’ NODDI and ASL images used by the PVC algorithm from one subject. Top row: MPRAGE and VFIn images; middle row: VFEn and VFISO; bottom row: CBF for short PLD (left) and long PLD (right). Supporting Image: Fig2.jpg ·Fig.2: Top: Extra-neurite GM CBF from short (left) & long (right) PLD acquisitions. Bottom: axial and sagittal views of Intra-neurite CBF for long PLD with areas in blue indicating ~zero signal. Conclusions: We combined NODDI with PVC ASL MRI to distinguish between blood flow in the extra- and intra-neurite compartments within GM. While these initial results look promising, more work is needed to test the sensitivity of this method and its feasibility for clinical applications. For example, a larger PLD range is needed to test whether the method can be used to detect inter-neurite subcortical flow. If successful, this method could prove invaluable in mapping blood flow with high spatial specificity.

The Cognitive reserve (CR) hypothesis was put forward to account for the variability in cognitive performance of patients with similar degrees of brain pathology. Compensatory neural activity within the frontal lobes has often been associated with CR. For the first time we investigated the independent effects of two CR proxies, education and NART IQ, on measures of executive function, fluid intelligence, speed of information processing, verbal short term memory (vSTM), naming, and perception in a sample of 86 patients with focal, unilateral frontal lesions and 142 healthy controls. We fitted multiple linear regression models for each of the cognitive measures and found that only NART IQ predicted executive and naming performance. Neither education nor NART IQ predicted performance on fluid intelligence, processing speed, vSTM or perceptual abilities. Education and NART IQ did not modify the effect of lesion severity on cognitive impairment. We also found that age significantly predicted performance on executive tests and the majority of our other cognitive measures, except vSTM and GNT. Age was the only predictor for fluid intelligence. This latter finding suggests that age plays a role in executive performance over and above the contribution of CR proxies in patients with focal frontal lesions. Overall, our results suggest that the CR proxies do not appear to modify the relationship between cognitive impairment and frontal lesions.

Dementia with Lewy bodies (DLB) causes elevated outlays for the National Health Systems due to high institutionalization rate and patients' reduced quality of life and high mortality. Furthermore, DLB is often misdiagnosed as Alzheimer's disease. These data motivate harmonized multicenter longitudinal cohort studies to improve clinical management and therapy monitoring. The Italian DLB study group of the Italian Neurological Society for dementia (SINdem) developed and emailed a semi-structured questionnaire to 572 national dementia centers (from primary to tertiary) to prepare an Italian large longitudinal cohort. The questionnaire surveyed: (1) prevalence and incidence of DLB; (2) clinical assessment; (3) relevance and availability of diagnostic tools; (4) pharmacological management of cognitive, motor, and behavioural disturbances; (5) causes of hospitalization, with specific focus on delirium and its treatment. Overall, 135 centers (23.6 %) contributed to the survey. Overall, 5624 patients with DLB are currently followed by the 135 centers in a year (2042 of them are new patients). The percentage of DLB patients was lower (27 ± 8 %) than that of Alzheimer's disease and frontotemporal dementia (56 ± 27 %) patients. The majority of the centers (91 %) considered the clinical and neuropsychological assessments as the most relevant procedure for a DLB diagnosis. Nonetheless, most of the centers has availability of magnetic resonance imaging (MRI; 95 %), electroencephalography (EEG; 93 %), and FP-CIT single photon emission-computerized tomography (SPECT; 75 %) scan for clinical applications. It will be, therefore, possible to recruit a large harmonized Italian cohort of DLB patients for future cross-sectional and longitudinal multicenter studies.

Objective: Memory deficits in patients with frontal lobe lesions are most apparent on free recall tasks that require the selection, initiation, and implementation of retrieval strategies. The effect of frontal lesions on recognition memory performance is less clear with some studies reporting recognition memory impairments but others not. The majority of these studies do not directly compare recall and recognition within the same group of frontal patients, assessing only recall or recognition memory performance. Other studies that do compare recall and recognition in the same frontal group do not consider recall or recognition tests that are comparable for difficulty. Recognition memory impairments may not be reported because recognition memory tasks are less demanding. Method: This study aimed to investigate recall and recognition impairments in the same group of 47 frontal patients and 78 healthy controls. The Doors and People Test was administered as a neuropsychological test of memory as it assesses both verbal and visual recall and recognition using subtests that are matched for difficulty. Results: Significant verbal and visual recall and recognition impairments were found in the frontal patients. Conclusion: These results demonstrate that when frontal patients are assessed on recall and recognition memory tests of comparable difficulty, memory impairments are found on both types of episodic memory test.