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Language disorders are among the primary obstacles in care and rehabilitation process following acquired brain injuries (ABI). While early cognitive screening is considered critical for sketching a reliable picture of patients' residual abilities and devising efficient therapeutic plans, it has been shown that commonly-used screening tools-which strongly rely on verbal materials-might be inappropriate when used with ABI patients. This study aimed at testing the robustness and validity of the Cognitive Assessment for Stroke Patients (CASP) battery-devised to minimize the use of verbal materials-and two gold-standards in clinical practice-i.e. Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA)-in presence of language comprehension difficulties. Forty-two ABI patients took part in the study. Half of the cohort was classified as aphasic. Participants underwent neuropsychological assessment including MMSE, MoCA and CASP, and completed the Token test to estimate language comprehension proficiency. The influence of linguistic ability on the outcomes of the screening tools was investigated. Regression analyses highlighted that, in aphasic patients, MMSE and MoCA scores proved to be significantly and remarkably determined by patients' proficiency in linguistic comprehension, while the outcome of the CASP battery was not significantly affected by language comprehension impairments.

This paper proposes a novel technique for the automatic detection of dementia based on the attentional matrices test (AMT) for selective attention assessment. The original test provides three matrices, of increasing difficulty, and the test taker is asked to mark target digits assigned. In our proposal, AMT was developed on a digitizing tablet, equipped with an electronic pen. Tablet technology enables the acquisition of additional measures to those that can be obtained by observing the execution of the traditional paper-based test. These measures reflect the dynamics of the handwriting process, particularly the pauses and hesitations while the pen is not in contact with the pad surface. Handwriting measures can then serve as an input to machine learning algorithms to automatize disease detection. In contrast to the traditional approach, dynamic handwriting analysis can provide a means to better evaluate the visual search of the patient, as well as motor planning. To evaluate the effectiveness of the proposal, a classification study was carried out involving 29 healthy control subjects and 36 demented patients. We employed different machine learning algorithms and an ensemble scheme. We observed the first matrix to be the most discriminating, while the ensemble of the best classification models over the three matrices provided the best classification performance [i.e., an area under the ROC curve (AUC) of 87.30% and a sensitivity of 86.11%]. Our proposal has the potential to provide a cost-effective and easy-to-use diagnostic tool, which may also support mass screening of the population.

Falls represent one of the most serious clinical problems in the elderly population. This risk is even more important in people suffering from neurodegenerative problems. This work aims to instrumentally assess the balance performance of elderly people and specifically those suffering from neurodegenerative diseases, to obtain an objective evaluation of their risk of falls. This paper presents a vision-based system made of three low-cost cameras, able to automatically infer important mobility parameters by observing the execution of well-established tests for stability assessment. This result is achieved by a dedicated image processing pipeline, which processes videos to get dynamic user skeletons, and the following strategy for information management, which targets to feature extraction. This information finally feeds a classifier, namely a decision tree, trained to predict the risk of fall of patients within 5 classes of interest. Actual experiments performed on actual video recordings prove a good agreement of results with those expected, labeled by expert therapists, with final prediction accuracy of 79.1%.

Education may play a key role in developing “cognitive reserve” against neurodegenerative dementia. In this work, we investigate for the first time if handwriting dynamics can serve as a quantitative indicator of this reserve. We carried out an exploratory study involving a sample of mild cognitive impairment (MCI) subjects, with high and low education respectively, and a sample of healthy elder controls. We asked them to perform three complex handwriting tasks on a digitizing tablet: drawing a clock; copying a check; writing a spontaneous sentence. Dynamic measures of the handwriting were then analyzed both with an unsupervised and a supervised machine learning approach. The results we obtained suggest that: (i) handwriting of MCI subjects with high reserve is quite similar to that of controls; (ii) handwriting of MCI subjects with lower reserve is easier to be distinguished from the other two. Dynamic handwriting analysis could provide a novel methodology to elucidate the still unknown mechanisms underlying brain resilience.

Diagnostic accuracy and reliable estimation of clinical evolution are challenging issues in the management of patients with disorders of consciousness (DoC). Longitudinal systematic investigations conducted in large cohorts of patients with DoC could make it possible to identify reliable diagnostic and prognostic markers. On the basis of this consideration, we devised a multicentre prospective registry for patients with DoC admitted to ten intensive rehabilitation units. The registry collects homogeneous and detailed data on patients' demographic and clinical features, neurophysiological and neuroimaging findings, and medical and surgical complications. Here we present the rationale and the design of the registry and the preliminary results obtained in 53 patients with DoC (vegetative state or minimally conscious state) enrolled during the first seven months of the study. Data at 6-month post-injury follow-up were available for 46 of them. This registry could be an important tool for collecting high-quality data through the application of rigorous methods, and it could be used in the routine management of patients with DoC admitted to rehabilitation settings.

The need for quick tools to sketch an early but accurate cognitive profile of patients who suffered brain damage or head trauma is of primary importance. Nonetheless, in the Italian context, the most-diffused screening tools are still those originally devised to diagnose dementia. The present pilot study then aimed at investigating the potential and feasibility of a novel screening battery, the Cognitive Assessment for Stroke Patients (CASP), in a sample of Italian patients by comparing it to Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) tests. A total of 29 neurology patients took part in the study. Participants underwent a screening procedure including the administration of MMSE, MoCA, and CASP. Data analysis suggested that the scores of the Italian version of the CASP are relatively less affected by the presence of language difficulties-common sequelae of stroke and head traumas-with respect to MMSE and MoCA ones. Furthermore, CASP scores proved to be highly correlated with both MMSE and MoCA scores, showing good clinical potential. Finally, the outcomes of administered tests proved not to be influenced by etiology or gender, and CASP scores showed a diminishing trend related to patients' age and a positive association with patients' education.

We assessed a program to promote constructive engagement, requests, and choice by a man with post-coma pervasive motor impairment and minimally conscious state. The program was based on learning principles and use of assistive technology (e.g., sensors to monitor the man’s responses and trigger environmental stimulation). The initial objective was the man’s acquisition of a thumb response to activate visual stimulation. Next objective was his acquisition of a dual vocal response (i.e., longer or shorter vocal utterances) to call his mother and sister who presented him with various stimuli. Then, an analysis was carried out of the man’s choice between vocal utterances (i.e., between mother and sister). Eventually, the thumb response and the dual vocal response were combined and an analysis of the man’s choice between these responses was conducted. Data indicated that the man learned the target responses and also provided evidence of purposeful choice between the vocal utterances as well as between such utterances and the thumb response. These data were discussed in terms of usefulness of the learning paradigm and assistive technology in providing persons with multiple disabilities and consciousness disorders the opportunity to advance their condition meaningfully.

Finding signs of learning in post-coma persons with profound multiple disabilities (i.e., in a vegetative state or minimally responsive) would underline (a) an awareness/consciousness of their responding and its links with environmental stimuli and (b) a positive development in their immediate situation with the possibility of treatment (rehabilitation) advances. This study was aimed at assessing signs of learning in two of these persons (i.e., two adults). The learning setup involved eye blinking as the persons’ responses and microswitch technology to detect such responses and to present stimuli. The technology consisted of an electronically regulated optic sensor mounted on an eyeglasses’ frame that the persons wore during the sessions and a control system connected to stimulus sources. The study involved an ABABCB sequence, in which A represented baseline periods, B intervention periods with stimuli contingent on the responses, and C a control condition with stimuli presented non-contingently. Data showed that the level of responding during the B phases was significantly higher than the levels observed during the A phases as well as the C phase (i.e., indicating clear signs of learning by both persons). The implications of these data for assessment and rehabilitation of post-coma persons with profound multiple disabilities are discussed.