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Whiteboards are ubiquitous fixtures in hospital rooms that may represent a ready-made patient engagement tool; yet, their use has only been minimally explored. This study examined the relationship between a standardized whiteboard communication process and patient activation by using the Patient Activation Measure (PAM ® ). Participants ( N = 172) that were optimally involved in whiteboard communication had significantly higher PAM ® scores compared to those who were suboptimally involved. PAM ® scores also correlated with self-reported role, with those endorsing active participation scoring higher than passive listeners. Accordingly, this study establishes a positive association between the structured use of whiteboards and patient activation.

The emotional and cognitive cerebellum has been explored by several studies in the past years. Recent evidence suggested the possible contribution of the cerebellum in processing emotional prosody, namely the ability to comprehend the emotional content of a given vocal utterance, likely mediated by anatomical and functional cerebello-prefrontal connections. In the present study, the involvement of a functional cerebello-prefrontal network in recognising emotional prosody was assessed by combining non-invasive anodal transcranial direct current stimulation (tDCS) over the right or the left cerebellum and functional Near Infrared Spectroscopy of the prefrontal cortex, in a double-blind within-subject experimental design on healthy participants. The results showed that right and, to a less extent, left cerebellar tDCS (as compared to sham stimulation) reduced neural activation in the prefrontal cortex while accuracy and reaction times at the vocal recognition task remained unchanged. These findings highlight functional properties of the cerebello-frontal connections and the psychophysiological effects of cerebellar brain stimulation, with possible clinical applications in psychiatric and neurological conditions., Competing Interests: Declarations. Ethics approval: The study was approved by the Institutional Ethic Committee and were in accordance with the 1964 Helsinki Declaration and its later amendments. Consent to participate: All participants gave their written informed consent to participate. Consent for publication: All authors consent to publication; all participants gave their written informed consent to publication. Conflicts of interest: The authors declare no competing interests. Open practice statement: Data or materials for the experiments are available upon request, and none of the experiments was preregistered., (© 2024. The Author(s).)

We investigated the role of humanisation in Visual Perspective-Taking (VPT) by testing whether and how agent's human-likeness and attractiveness ("hedonic quality") interact with social cues (action and eye gaze) in influencing the participants' disposition to embody another's perspective. In a VPT task, participants viewed scenes displaying an actor (human or robotic) grasping, gazing (or both) a target object, or adopting a still posture, and were required to judge the left/right location of the target, without receiving any instruction on the perspective to be assumed. Across two studies, we selected human and robotic agents to use as actors in the VPT task. Results consistently demonstrated that participants could be effectively clustered by a data-driven method into two perspective-taking styles, depending on the presence of a systematic tendency to locate the target object in the VPT scenarios from own (egocentric) or the actor's (altercentric) point of view. The human versus nonhuman nature of the agent seemed able to affect the participants' egocentric or altercentric tendency whereas both the agent's hedonic quality and social cues were not able to influence this propensity. Identifying the factors influencing altercentrism during human-robot interactions can be essential for developing artificial agents favouring user's acceptance and willingness to interact. In this respect, considering differences among individuals in their propensity to take another's point of view may be of central importance. Clustering approaches can represent a useful means to capture interindividual differences in this central aspect of human social cognition., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) is the most widely used in clinical practice and the least time-consuming battery to estimate cognitive function in adults with Multiple Sclerosis (MS), while it has been included in few studies on young MS, also because of the absence of normative values., Objective: The aim of this study is to evaluate the impact of age, sex and education on BICAMS scores in a young adolescent population., Methods: We administered the BICAMS to 169, 11-to-18-year-old, healthy subjects. Linear regression models were used to assess the impact of age, sex, and education on sub-test scores. When statistically significant (p < 0.05), we used the regression coefficient to correct the raw scores., Results: younger age was associated with worse performance on SDMT (β = 1.76; p < 0.05), CVLT-II (β = 3.33; p < 0.05) and BVMT-R (β = 0.62; p < 0.05). Female sex was associated SDMT (β = 2.75 (p < 0.05) and CVLT-II (β = 2.51 (p < 0.05). Educational attainment was associated with better performance on SDMT (β = 1.79 (p = < 0.05) and BVMT-R (β = 0.61; p < 0.05). Cut-off points were suggested at the 5th lowest percentile., Conclusion: Age, sex, and education must be accounted for when applying the BICAMS to young population. Its use in everyday assessment of patients with Pediatric Onset Multiple Sclerosis (POMS) could help to compare and combine data across centers, identifying patients requiring a comprehensive evaluation and ad hoc cognitive stimulation programs., Competing Interests: Declarations. Competing interests: The authors declare that they have no conflict of interest., (© 2024. Fondazione Società Italiana di Neurologia.)

Background: Major depression in the older population has a profound impact on patients' quality of life and is associated with an increased risk of developing several medical illnesses. Psychophysiological methods, such as electroencephalography (EEG), functional near-infrared spectroscopy (fNIRS), and eye-tracking, have provided evidence of physiological changes associated with depression in adult life. However, these aspects have not been thoroughly investigated during late-life (over 60 years of age)., Methods: A systematic review of the scientific literature covering the studies published between 1990 and 2022 was performed to describe the current evidence on easily attainable psychophysiological factors (detected by EEG, fNIRS and eye-tracking) associated with depression in late-life., Results: Twelve studies were included in the systematic review. The included studies showed some consistent physiological patterns associated with late-life depression, such as brain hypoactivation in frontal and temporal areas and attentional biases toward emotional stimuli. No reliable patterns in EEG asymmetry and power spectrum were found, in contrast to studies on early-life depression., Limitations: The small number of available studies, together with the heterogeneity in the techniques and methods used, highlight the need for further research to reliably identify the psychophysiological aspects of depression in late-life., Conclusions: Physiological indices of late-life depression, as assessed by EEG, fNIRS and eye-tracking, may differ from those of early-life. The study of these indices could better clarify the physiological mechanisms underlying late-life depression with possible clinical and research implications. Recommendations for future research are also discussed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction: False memory can be defined as remembering something that did not happen. To a certain extent it is a normal phenomenon, but its occurrence seems to increase in healthy and pathological aging, possibly providing relevant clues on some clinical conditions in the spectrum of dementia. We adapted a well-established Deed-Roediger-McDermott paradigm, frequently used in experimental contexts, to devise a new neuropsychological assessment tool, the False Recognition Test (FRT), that can investigate classical facets of episodic memory performance (i.e. free recall and recognition), and assess proneness to produce semantically related and non-semantic false memories. Here we describe the FRT and provide normative data and correction grids to consider the possible effects of age, gender, and education on the FRT scores., Method: Two-hundred and thirty-two Italian healthy individuals (99 male) aged 18-91 years, with different educational levels (from primary to university) underwent the FRT, together with validated tests for cognitive screening and episodic memory assessment and one scale for depression., Results: Multiple linear regression analysis revealed that age and education significantly influenced performance on FRT. From the derived linear equations, we provide correction grids for the raw scores of the FRT, and equivalent scores estimated using a nonparametric method. Correlational analysis showed significant associations between FRT subscores and cognitive, executive and memory functions, and depression., Conclusion: The FRT may constitute a useful instrument for both clinical and research purposes., (© 2024. The Author(s).)

Introduction: Spatial construction is a complex ability involving attention, global/local visual processing, mental representation, visuo-motor coordination and, to varying extent, working memory and executive functions, and verbal abilities. In developmental neuropsychology, little attention has been paid to comprehend whether and to what extent the above cognitive processes are involved in two main spatial construction tasks, that is drawing and block building., Method: We used path analysis to test shared and specific effects of verbal and spatial working memory, spatial attention, inhibition, verbal abilities (vocabulary and naming), figure disembedding, mental rotation, and visual-motor coordination, as well as of demographics (sex, age and socio-economic status), on two classical drawing (Rey-Osterrieth Complex Figure; ROCF) and block building (Block design; BD) tasks in a sample of 195 typically developing children (age range: 7-11 years)., Results: Figure disembedding and visuo-motor coordination were the only shared predictors of both spatial construction tasks. Moreover, ROCF score was directly related with spatial attention and inhibition, while BD score was directly related with sex, vocabulary, mental rotation and backward spatial working memory., Discussion: These findings distinguish between abilities involved in spatial construction regardless of the type of task and those specifically related to ROCF or Block Design, thus providing clues relevant to neuropsychological assessment and intervention in children with spatial construction disorders., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Zappullo, Senese, Trojano, Cecere and Conson.)

Background: NOTCH3 encodes a transmembrane receptor critical for vascular smooth muscle cell function. NOTCH3 variants are the leading cause of hereditary cerebral small vessel disease (SVD). While monoallelic cysteine-involving missense variants in NOTCH3 are well-studied in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), patients with biallelic variants in NOTCH3 are extremely rare and not well characterised., Methods: In this study, we present clinical and genetic data from 25 patients with biallelic NOTCH3 variants and conduct a literature review of another 25 cases (50 patients in total). Brain magnetic resonance imaging (MRI) were analysed by expert neuroradiologists to better understand the phenotype associated with biallelic NOTCH3 variants., Findings: Our systematic analyses verified distinct genotype-phenotype correlations for the two types of biallelic variants in NOTCH3. Biallelic loss-of-function variants (26 patients) lead to a neurodevelopmental disorder characterised by spasticity, childhood-onset stroke, and periatrial white matter volume loss resembling periventricular leukomalacia. Conversely, patients with biallelic cysteine-involving missense variants (24 patients) fall within CADASIL spectrum phenotype with early adulthood onset stroke, dementia, and deep white matter lesions without significant volume loss. White matter lesion volume is comparable between patients with biallelic cysteine-involving missense variants and individuals with CADASIL. Notably, monoallelic carriers of loss-of-function variants are predominantly asymptomatic, with only a few cases reporting nonspecific headaches., Interpretation: We propose a NOTCH3-SVD classification depending on dosage and variant type. This study not only expands our knowledge of biallelic NOTCH3 variants but also provides valuable insight into the underlying mechanisms of the disease, contributing to a more comprehensive understanding of NOTCH3-related SVD., Funding: The Wellcome Trust, the MRC., Competing Interests: Declaration of interests Wendy Chung is on the board of directors of Prime Medicine. Stephan Zuchner has received consultancy honoraria from Neurogene, AegleaBioTherapeutics, Applied Therapeutics, and is an unpaid officer of the TGP foundation, all unrelated to the present manuscript. Elisa Fazzi has received honoraria from GW Pharma. Nicola De Stefano has received honoraria from Biogen-Idec, Genzyme, Immunic, Merck, Novartis, Roche, Celgene, and Teva for consulting services, speaking, and travel support. He serves on advisory boards for Merck, Novartis, Biogen-Idec, Immunic, Roche, and Genzyme, and he has received research grant support from the Italian MS Society. Lyn R Griffiths has received grants from the Australian National Health and Medical Research Council, Variant Bio, US Department of Defense and US Migraine Research Foundation as well as honoraria from Teva, Springer Nature, and Association of Migraine Disorders and she is Board of Censors, Diagnostic Genomics Human Genetics Assoc Australia and member of the Human Genetics Australasia Advisory Board. Hugh S Markus has received peer reviewed grants from the Medical Research Council, British Heart Foundation, National Institute of Health Research, and the Alzheimer Society, and is editor in chief of the International Journal of Stroke., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

The mini-Ultimatum Game (mini-UG) is a bargaining game used to assess the reactions of a responder to unfair offers made by a proposer under different intentionality conditions. Previous studies employing this task showed the activation of responders' right temporoparietal junction (rTPJ), which could be related to its involvement in judgments of intentionality. To verify this hypothesis, in the present study we applied online transcranial magnetic stimulation (TMS) over the rTPJ in responders during the mini-UG, in which we manipulated intention attribution implicitly. A cover story was employed to induce participants to believe they were interacting with another agent. We expected that interfering with the rTPJ could affect the ability of responders to assume proposers' perspective, producing higher rates of rejections of unfair offers when offers are perceived as independent from responders' intentionality to inequality. Twenty-six healthy women voluntarily participated in the study. In the mini-UG, an unfair distribution of the proposer (8/2 offer) was pitted against one of three alternative offers: fair-alternative (5/5), no-alternative (8/2), hyperfair-alternative (2/8). During the task, a train of TMS pulses was delivered at proposers' offer presentation in blocks of active (rTPJ) or control (Vertex) stimulation according to an ABAB design. As expected, findings showed that rejection of the no-alternative offers was higher under TMS stimulation of the rTPJ compared with the control TMS. This effect was modulated by the degree of trustworthiness in the cover story. These data contribute defining the mechanisms and brain areas underpinning social decision making as assessed by bargaining tasks., (© 2024. The Author(s).)

Background: Innovative digital solutions are shaping a new concept of dementia care, opening additional venues for prevention, diagnosis, monitoring and treatment. Hereby, we report the development of a tablet-based teleneuropsychology platform (Tenèpsia®), from concept to certification as Medical Device (MD) Class IIA, as per new MD regulation 745/2017., Methods: The platform was designed for the remote cognitive evaluation and created thanks to the effort of a collaborative working group including experts from three Italian scientific societies and Biogen Italia S.r.l. (hereafter "Biogen"), and developers from Xenia Reply and Inside AI. The development strategy was guided by converting traditional paper-and-pencil tests into digital versions while maintaining comparable neuropsychological features and optimizing patient accessibility and user experience. The experts focused on the choice and adaptation of traditional neuropsychology measures for a 45-min teleneuropsychology assessment., Results: The developers created a web and a mobile interface, respectively, for the professional (neuropsychologist) and non-professional (patient and caregiver) use. Recording of voice, drawing and typing information was enabled. Instant dashboards provide a quick overview of the patient's condition. Simulation activities were performed to obtain MD certification, valid across Europe., Conclusion: Neuropsychology services will benefit from the implementation in clinics of harmonized digital tools with adequate scientific and technological standards. The use of digital cognitive testing for the diagnosis of mild cognitive impairment is expected to enhance patient and clinician outcomes through simplified, digital objective data collection, sparing of time and resources, with a positive impact on healthcare costs and access to treatments, reducing inequalities and delays in diagnosis and cure., (© 2024. Fondazione Società Italiana di Neurologia.)

Anderson-Fabry disease (AFD) is a genetic sphingolipidosis involving virtually the entire body. Among its manifestation, the involvement of the central and peripheral nervous system is frequent. In recent decades, it has become evident that, besides cerebrovascular damage, a pure neuronal phenotype of AFD exists in the central nervous system, which is supported by clinical, pathological, and neuroimaging data. This neurodegenerative phenotype is often clinically characterized by an extrapyramidal component similar to the one seen in prodromal Parkinson's disease (PD). We analyzed the biological, clinical pathological, and neuroimaging data supporting this phenotype recently proposed in the literature. Moreover, we compared the neurodegenerative PD phenotype of AFD with a classical monogenic vascular disease responsible for vascular parkinsonism and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). A substantial difference in the clinical and neuroimaging features of neurodegenerative and vascular parkinsonism phenotypes emerged, with AFD being potentially responsible for both forms of the extrapyramidal involvement, and CADASIL mainly associated with the vascular subtype. The available studies share some limitations regarding both patients' information and neurological and genetic investigations. Further studies are needed to clarify the potential association between AFD and extrapyramidal manifestations.

Objective: The capacity to take another person's visual perspective is pivotal for solving mindreading tests, such as Theory of Mind (ToM) tasks, but most of them heavily rely on domain-general abilities (e.g., language, executive functions). Here we present a novel battery of visual perspective-taking tests for child neuropsychological assessment, the Perspective Battery (PERBAT), which poses a limited load on domain-general abilities., Methods: The battery includes four tests: i) Block Building; ii) Hide and Seek; iii) Deceptive Figures; iv) Double-Sided Shelf. We administered the PERBAT to 126 typically developing preschoolers (65 males; 3-6-year-old); the participants also performed classical tests of social cognition, language, and nonverbal abstract reasoning., Results: The scores of all the PERBAT tests were significantly and positively related with age and scores of the classical social cognition tests, but not with scores of the language and nonverbal abstract reasoning tests., Conclusions: The PERBAT could represent a useful neuropsychological tool providing a comprehensive assessment of visual perspective-taking skills in preschool children. Future investigation is needed to examine the validity of the PERBAT with neurotypical samples across countries, race, ethnicity, and language as well as with clinical populations. Longitudinal studies are also encouraged to examine whether early visual perspective-taking weaknesses are associated with later development of mindreading skills.

Background and Purpose: The prognosis of prolonged (28 days to 3 months post-onset) disorders of consciousness (pDoC) due to anoxic brain injury is uncertain. The present study aimed to evaluate the long-term outcome of post-anoxic pDoC and identify the possible predictive value of demographic and clinical information., Method: This is a systematic review and meta-analysis. The rates of mortality, any improvement in clinical diagnosis, and recovery of full consciousness at least 6 months after severe anoxic brain injury were evaluated. A cross-sectional approach searched for differences in baseline demographic and clinical characteristics between survivors and non-survivors, patients improved versus not improved, and patients who recovered full consciousness versus not recovered., Results: Twenty-seven studies were identified. The pooled rates of mortality, any clinical improvement and recovery of full consciousness were 26%, 26% and 17%, respectively. Younger age, baseline diagnosis of minimally conscious state versus vegetative state/unresponsive wakefulness syndrome, higher Coma Recovery Scale Revised total score, and earlier admission to intensive rehabilitation units were associated with a significantly higher likelihood of survival and clinical improvement. These same variables, except time of admission to rehabilitation, were also associated with recovery of full consciousness., Conclusions: Patients with anoxic pDoC might improve over time up to full recovery of consciousness and some clinical characteristics can help predict clinical improvement. These new insights could support clinicians and caregivers in the decision-making on patient management., (© 2023 European Academy of Neurology.)

Previous evidence suggested that spontaneous eye blinking changes as a function of the attentional focus. In particular, eye blink rate (EBR) tends to increase when attention is directed to internal versus environmental processing. Most studies on this issue compared eye blinking during visual and mental imagery tasks, and interpreted the increase in EBR as a mechanism to focus cognitive resources on internal processing by disengaging attention from interfering information. However, since eye blinking also depends on the sensory modality of the task, the findings might be influenced by a modality-specific effect. In the present Registered Report we aim at investigating whether the environmental versus internal attentional focus can affect spontaneous blinking behaviour in non-visual tasks as well, in conditions where visual stimuli are not relevant. In a within-subject design, healthy participants performed an interoceptive task (i.e., heartbeat counting) and an auditory task in which pre-recorded heartbeats were presented aurally; during both tasks irrelevant visual stimuli were also presented. In a further control condition with the same auditory and visual stimuli, the participants were required to focus their attention on visual stimuli. Participants' EBR was recorded during each task by means of an eye-tracking system. We found that, although the interoceptive task was more difficult than the auditory and visual tasks, participants' EBR decreased by a comparable level in all tasks with respect to a rest condition, with no differences between internal versus environmental conditions. The present findings do not support the idea that EBR is modulated by an internal versus external focus of attention, at least in presence of controlled visual stimulation., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: In amyotrophic lateral sclerosis (ALS), gait abnormalities contribute to poor mobility and represent a relevant risk for falls. To date, gait studies in ALS patients have focused on the motor dimension of the disease, underestimating the cognitive aspects., Methods: Using a wearable gait analysis device, we compared gait patterns in ambulatory ALS patients with mild cognitive impairment (ALS MCI+; n = 18), and without MCI (ALS MCI-; n = 24), and healthy subjects (HS; n = 16) under two conditions: (1) normal gait (single task) and (2) walking while counting backward (dual task). Finally, we examined if the occurrence and number of falls in the 3 months following the baseline test were related to cognition., Results: In the single task condition, ALS patients, regardless of cognition, displayed higher gait variability than HS, especially for stance and swing time (p < 0.001). The dual task condition revealed additional differences in gait variability parameters between ALS MCI+ and ALS MCI- for cadence (p = 0.005), stance time (p = 0.04), swing time (p = 0.04) and stability index (p = 0.02). Moreover, ALS MCI+ showed a higher occurrence (p = 0.001) and number of falls (p < 0.001) at the follow-up. Regression analyses demonstrated that MCI condition predicted the occurrence of future falls (β = 3.649; p = 0.01) and, together with executive dysfunction, was associated with the number of falls (cognitive impairment: β = 0.63; p < 0.001; executive dysfunction: β = 0.39; p = 0.03), regardless of motor impairment at clinical examination., Conclusion: In ALS, MCI is associated with exaggerated gait variability and predicts the occurrence and number of short-term falls., (© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Several studies demonstrated that individuals are more likely to remember emotional than neutral information; this phenomenon is known as emotional enhancement of memory (EEM). Adults generally tend to remember negative information more efficiently than neutral or positive items. In contrast, healthy elders seem to show an opposite bias for positive information, but results are inconsistent, also because during aging, elaboration of emotional information could change as a consequence of cognitive impairment. In this systematic review and meta-analysis, we conducted literature search of studies investigating emotion memory biases in mild cognitive impairment (MCI) and Alzheimer's disease (AD) on PubMed, Scopus and PsycINFO databases following PRISMA guidelines. The findings showed that emotional memory biases are still present despite the presence of cognitive impairment, both in MCI and at least in early stages of AD. However, the direction of emotion memory biases is not consistent across studies. These results suggest that patients with cognitive impairment might still benefit from EEM and help to define targets of intervention for cognitive rehabilitation in pathological aging., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Memory deficits in mild cognitive impairment related to Parkinson's disease (PD-MCI) are quite heterogeneous, and there is no general agreement on their genesis., Objectives: To define memory phenotypes in de novo PD-MCI and their associations with motor and non-motor features and patients' quality of life., Methods: From a sample of 183 early de novo patients with PD, cluster analysis was applied to neuropsychological measures of memory function of 82 patients with PD-MCI (44.8%). The remaining patients free of cognitive impairment were considered as a comparison group (n = 101). Cognitive measures and structural magnetic resonance imaging-based neural correlates of memory function were used to substantiate the results., Results: A three-cluster model produced the best solution. Cluster A (65.85%) included memory unimpaired patients; Cluster B (23.17%) included patients with mild episodic memory disorder related to a "prefrontal executive-dependent phenotype"; Cluster C (10.97%) included patients with severe episodic memory disorder related to a "hybrid phenotype," where hippocampal-dependent deficits co-occurred with prefrontal executive-dependent memory dysfunctions. Cognitive and brain structural imaging correlates substantiated the findings. The three phenotypes did not differ in terms of motor and non-motor features, but the attention/executive deficits progressively increased from Cluster A, through Cluster B, to Cluster C. This last cluster had worse quality of life compared to others., Conclusions: Our results demonstrated the memory heterogeneity of de novo PD-MCI, suggesting existence of three distinct memory-related phenotypes. Identification of such phenotypes can be fruitful in understanding the pathophysiological mechanisms underlying PD-MCI and its subtypes and in guiding appropriate treatments. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society., (© 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Atypical Parkinsonism (AP) syndromes are characterized by a wide spectrum of non-motor symptoms including prominent attentional and executive deficits. However, the cognitive profile of AP and its differences and similarities with that of Parkinson's Disease (PD) are still a matter of debate. The present meta-analysis aimed at identifying patterns of cognitive impairment in AP by comparing global cognitive functioning, memory, executive functions, visuospatial abilities, language, non-verbal reasoning, and processing speed test performances of patients with AP relative to healthy controls and patients with PD. All investigated cognitive domains showed a substantial impairment in patients with AP compared to healthy controls. When AP syndromes were considered separately, their cognitive functioning was distributed along a continuum from Multiple Systemic Atrophy at one extreme, with the least impaired cognitive profile (similar to that observed in PD) to Progressive Supranuclear Palsy, with the greatest decline in global cognitive and executive functioning (similar to Corticobasal Syndrome). These findings indicate that widespread cognitive impairment could represent an important clinical indicator to distinguish AP from other movement disorders., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The recovery of independent gait represents one of the main functional goals of the rehabilitative interventions after stroke but it can be hindered by the presence of unilateral spatial neglect (USN). The aim of the paper is to study if the presence of USN in stroke patients affects lower limb gait parameters between the two body sides, differently from what could be expected by the motor impairment alone, and to explore whether USN is associated to specific gait asymmetry. Thirty-five stroke patients (right or left lesion and ischemic or hemorrhagic etiology) who regained independent gait were assessed for global cognitive functioning and USN. All patients underwent a gait analysis session by using a wearable inertial system, kinematic parameters were computed. Enrolled patients presented altered motion parameters. Stroke patients with USN showed specific asymmetries in the following parameters: stance phase, swing phase, and knee range of motion. No differences in the clinical scores were found as the presence of USN. The presence of USN was associated with a specific form of altered gait symmetry. These findings may help clinicians to develop more tailored rehabilitative training to enhance gait efficacy of patients with motor defects complicated by the presence of selected cognitive impairments. Overview of the experiment setup. The workflow shows: diagnosis of unilateral spatial neglect by the neuropsychologist, sensors placement, gait analysis protocol and evaluation of the gait asymmetry together with the statistically significant features., (© 2022. International Federation for Medical and Biological Engineering.)

Prognosis of prolonged Disorders of Consciousness (pDoC) is influenced by patients' clinical diagnosis and Coma Recovery Scale-Revised (CRS-R) total score. We compared the prognostic accuracy of a novel Consciousness Domain Index (CDI) with that of clinical diagnosis and CRS-R total score, for recovery of full consciousness at 6-, 12-, and 24-months post-injury. The CDI was obtained by a combination of the six CRS-R subscales via an unsupervised machine learning technique. We retrospectively analyzed data on 143 patients with pDoC (75 in Minimally Conscious State; 102 males; median age = 53 years; IQR = 35; time post-injury = 1-3 months) due to different etiologies enrolled in an International Brain Injury Association Disorders of Consciousness Special Interest Group (IBIA DoC-SIG) multicenter longitudinal study. Univariate and multivariate analyses were utilized to assess the association between outcomes and the CDI, compared to clinical diagnosis and CRS-R. The CDI, the clinical diagnosis, and the CRS-R total score were significantly associated with a good outcome at 6, 12 and 24 months. The CDI showed the highest univariate prediction accuracy and sensitivity, and regression models including the CDI provided the highest values of explained variance. A combined scoring system of the CRS-R subscales by unsupervised machine learning may improve clinical ability to predict recovery of consciousness in patients with pDoC.

Background: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a monogenic small-vessel disease that is characterized by a wide range of neurologic and neuropsychological impairments. Constructional impairments have been reported in some cases but have never been assessed systematically., Objective: To evaluate constructional abilities and their cognitive and neural correlates in nondemented individuals with CADASIL., Method: Thirty individuals with CADASIL who were not affected by clinically relevant cognitive deterioration and 30 healthy controls (HC) underwent an extensive cognitive assessment and paper-and-pencil visuoconstructional tasks in order to detect constructional impairments. Performance on the visuoconstructional tasks was correlated with the cognitive assessment scores and with quantitative indices of regional gray matter atrophy (obtained via FreeSurfer image analysis) and white matter involvement., Results: The individuals with CADASIL achieved significantly lower scores on the cognitive assessment compared with the HC. Poor visuoconstructional abilities were observed in seven (23.3%) of the individuals with CADASIL when performing the copy drawing task and in nine (30%) when performing the Rey Complex Figure Test. Logistic regression revealed that visuoconstructional impairments were significantly associated with scores on the Frontal Assessment Battery and the Attentional Matrices Test. Morphometric results revealed that scores on the visuoconstructional tasks were related to gray matter atrophy of the left frontal lobe and right parietal lobe., Conclusion: Impairments on visuoconstructional tasks are quite common in individuals with CADASIL, even in the lack of clinically relevant cognitive deterioration, and are critically related to frontal and parietal atrophy., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Purpose: Although disabling fatigue is common in Parkinson disease (PD), available consensus-based diagnostic criteria have not yet been empirically validated. The aim of this study was to evaluate the clinimetric properties of the criteria., Methods: A sample of outpatients with PD was evaluated for demographic, clinical, behavioral, and cognitive features. Fatigue was diagnosed according to the new diagnostic criteria and was rated by means of the Parkinson Fatigue Scale (PFS) and Fatigue Severity Scale (FSS). Acceptability, concurrent and discriminant validity, and interrater reliability were evaluated with binary logistic regression analyses and Cohen kappa (κ)., Results: Of 241 included patients, 17 (7.1%) met the diagnostic criteria for PD-related fatigue. Eight of nine symptoms described in Section A of the diagnostic criteria occurred in &gt;50% of patients with fatigue. Acceptability (missing data = 0.8%) of the criteria was good, as was their concurrent validity with the PFS (odds ratio = 3.65) and FSS (odds ratio = 3.63). The discriminant validity of fatigue criteria with other PD-related behavioral and cognitive features was good (odds ratio &lt; 1.68). The interrater reliability was excellent (κ = 0.92)., Conclusions: This is the first study to test the clinimetric properties of case definition diagnostic criteria for PD-related fatigue. Our results suggest that current diagnostic criteria may be useful in both clinical practice and research. Future longitudinal studies should examine their long-term stability., (© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

In two studies, we used the Gottschaldt's Hidden Figure Test (GHFT) for assessing figure disembedding ability in children aged 7-11. Study 1 demonstrated in a large sample of typically developing children that GHFT accuracy and time scores differed across age groups, without sex and socioeconomic differences. Thus, we provided normative data only taking into account children's age. In Study 2, GHFT normative values were used to assess children with autism, who were also compared with a closely age-matched group of typical controls. Children with autism achieved time scores at or above the 50th centile and significantly differed from the controls for time score. The GHFT seems a valuable tool for defining the cognitive profile of children with autism., (© 2021. The Author(s).)

The COVID-19 pandemic and the measures to avert contagion heavily impacted individuals' mental health. In the present cross-sectional study, we investigate the relationship between cognitive reserve, coping modalities and the perceived stress during a chronic stage of COVID-19 pandemic by online administration of three standardized questionnaires in a sample of healthy volunteers covering a large lifespan (18-85 years). We found that positive orientation to problems and higher levels of cognitive reserve were associated with lower levels of stress. Conversely, coping strategies involving negation, substance consumption, and appeal to other people and religion to face everyday life, together with higher education, were associated with higher levels of stress. These results shade light on the long-term psychological consequences of COVID-19 and call for the development of psychological interventions improving coping and cognitive reserve, to preserve and restore mental health following the pandemic., Competing Interests: None., (© 2022 Elsevier Ltd. All rights reserved.)

Background: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with progressive loss of upper and lower motor neurons. Non-motor-symptoms, such as cognitive, emotional, autonomic, and somatosensory alterations, have been also described. Interoception represents the link between the body and brain, since it refers to the ability to consciously perceive the physical condition of the inner body, including one's heartbeat (i.e., interoceptive sensitivity, IS)., Objectives: To evaluate IS in ALS patients by means of a well-established task: the heartbeat perception task. Moreover, we evaluated possible correlations between IS and neuropsychological, affective, and disease-related characteristics., Methods: Fifty-five ALS patients (mean-age = 60.3 ± 12.5 years; mean disease-duration = 20.9 ± 18.8 months) and 41 caregivers (CG) underwent the heartbeat perception task and an extensive evaluation of motor, cognitive, body awareness, affective, and emotion domains., Results: ALS patients showed lower IS than CG (0.68 ± 0.24 vs 0.82 ± 0.16; p = 0.003). Significant correlations were found between IS and self-reported measures of alexithymia (subscale of Toronto Alexithymia scale-20 "difficulties in describing feelings"; rho =  - .391, p = .003) and interoceptive awareness (subscale of Multidimensional assessment of interoceptive awareness "not worrying about pain"; rho = .405, p = .002). No significant differences were found on questionnaires for depression and anxiety between patients with ALS and their caregivers (p > .05)., Conclusions: ALS patients show reduced interoceptive sensitivity that is associated with poorer ability to describe feelings and with lower focalization on pain, regardless of cognitive and motor impairment. Alteration of interoception may represent a specific behavioural sign within the spectrum of emotion processing deficits described in ALS patients., (© 2022. The Author(s).)

Background: Cognitive dysfunctions are highly prevalent in multiple sclerosis (MS) and negatively impact occupational and social functioning., Objective: In the present longitudinal study, we aimed at modeling cognitive changes and at assessing whether apathy could be a predictor of cognitive decline in MS., Methods: We assessed 67 people with MS at two-time points (baseline, T0; 4-year follow-up, T1), by means of several clinical, behavioural, and cognitive measures. We used a delta approach to measure cognitive decline during the follow-up period. We applied a mixed factorial design and a linear regression model to explore factors associated with cognitive changes over time., Results: A higher level of apathy at baseline predicted the progressive cognitive decline at follow-up, whereas a higher level of depression did not. Among demographic and clinical characteristics, only low education level was significantly associated with cognitive decline over time. Interestingly, participants with persistent apathy (diagnosis of apathy at T0 and T1, A+A+) and those who developed apathy (A-A+) showed poorer inhibitory control and a larger decline in executive functioning during the 4-year follow-up than participants who had never received the diagnosis of apathy (A-A-)., Conclusion: Apathy represents an early marker of cognitive decline in MS. These findings have important clinical and prognostic implications., (Copyright © 2022. Published by Elsevier B.V.)