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Cognitive reserve (CR) represents the adaptive response of the cognitive system responsible for preserving normal functioning in the face of brain damage. Experiential factors such as education, occupation, and leisure activities influence the development of CR. Theoretically, such factors build up from childhood and across adulthood. Thus, appropriate tools to define and measure CR as early as adolescence are essential to understand its developmental processes. To this aim, we introduce the construct of “Cognitive Reserve Potential” (CRP) and its corresponding index of experiential factors tailored to youth. We investigated prototypical youth exposures potentially associated with the lifelong development of CR (e.g., sport practice, musical experiences, cultural activities, and relationships with peers and family). Principal component analysis and confirmatory factor analysis identified and replicated the CRP factor structure on two independent samples of Italian students: N = 585 (295 F) and N = 351 (201 F), ages 11 to 20. CRP was associated mainly with family socio-cultural status (i.e., socioeconomic status [SES], Home Possessions, and Books at Home). Results confirmed the strength of the factorial model and warranted the proposal of the CRP-questionnaire as an innovative tool for understanding CR evolutionary dynamics.

Background: Despite the relevance of telephone-based cognitive screening tests in clinical practice and research, no specific test assessing executive functioning is available. The present study aimed at standardizing and providing evidence of clinical usability for the Italian telephone-based Frontal Assessment Battery (t-FAB). Methods: The t-FAB (ranging 0–12), comprising two subtests, has two versions: one requiring motor responses (t-FAB-M) and the other verbal responses (t-FAB-V). Three hundred and forty-six Italian healthy adults (HPs; 143 males; age range = 18–96 years; education range = 4–23 years) and 40 participants with neurological diseases were recruited. To HPs, the t-FAB was administered along with a set of telephone-based tests: MMSE, verbal fluency (VF), backward digit span (BDS). The in-person version of the FAB was administered to both HPs and clinical groups. Factorial structure, construct validity, inter-rater and test–retest reliability, t-FAB-M vs. t-FAB-V equivalence and diagnostic accuracy were assessed. Norms were derived via Equivalent Scores. Results: In HPs, t-FAB measures yielded high inter-rater/test–retest reliability (ICC =.78–.94), were internally related (p ≤.005) and underpinned by a single component, converging with the telephone-based MMSE, VF, BDS (p ≤.0013). The two t-FAB versions were statistically equivalent in clinical groups (ps of both equivalence bounds <.001). Education predicted all t-FAB scores (p <.001), whereas age only the t-FAB-M score (p ≤.004). t-FAB scores converge with the in-person FAB in HPs and clinical groups (rs =.43–.78). Both t-FAB versions were accurate in discriminating HPs from the clinical cohort (AUC =.73-.76). Discussion: The t-FAB is a normed, valid, reliable and clinically usable telephone-based cognitive screening test to adopt in both clinical and research practice.

Background: The Italian telephone-based Mini-Mental State Examination (Itel-MMSE), despite being psychometrically sound, has shown relevant ceiling effects, which may negatively impact the interpretation of its scores. In address to overcome such an issue, this study aimed at providing item-level insights on the Itel-MMSE through Item Response Theory (IRT) analyses. Methods: Five-hundred and sixty-seven healthy Italian adults (227 males, 340 females; mean age: 51 ± 17 years, range 18–96; mean education: 13.31 ± 4.3 years). A two-parameter logistic IRT model was implemented to assess item discrimination and difficulty of the Itel-MMSE. Construct unidimensionality, statistical independence of items, and model and item fit were tested. Informativity levels were also assessed graphically. Results: With respect to the Itel-MMSE total score, ceiling effects were found in 92.7% of participants. Unidimensionality was violated; both model and item fit were poor; a few items showed statistical dependence. Both the whole test and its items proved to be scarcely informative, especially for medium-to-high levels of ability, except for attention and spatial orientation subtests, which consistently yielded the highest discriminative capability. Discussion: The Itel-MMSE appears to be most informative in low-performing healthy individuals. However, the present findings should not lead practitioners to aprioristically equate ceiling effects/low informativity to clinical uselessness. Items assessing attention and, to a lesser extent, spatial orientation appear to be the most informative.

Normative data of neuropsychological tests typically consider the effect of demographic variables like age and education on performance. However, a broad literature has shown that, after the school age, other cognitively stimulating experiences (e.g., occupational attainment and a variety of leisure-time activities) may increase and build up cognitive reserve (CR), which is positively associated with better performance in many neuropsychological tests. With these premises, we investigated the predictive capability of education and a life-experience proxy of CR on a widely used cognitive screening, i.e., the Montreal Cognitive Assessment (MoCA). Results show that models including the more comprehensive life-experience CR proxy performed better than models including Education. Based on the results of our analyses we provide normative data and cut-offs on 440 Italian individuals aged 50-90 years, by taking into account, for the first time for the Italian population, a CR index, together with demographic variables and Education, in the calculation of regression-based norms. Accounting for life-experience CR proxies can improve the accuracy of normative data and allow a finer estimation of cognitive performance, which lead to a more tailored approach to patient assessment.

IMPORTANCE Cerebral amyloidosis is a key abnormality in Alzheimer disease (AD) and can be detected in vivo with positron emission tomography (PET) ligands. Although amyloid PET has clearly demonstrated analytical validity, its clinical utility is debated. OBJECTIVE To evaluate the incremental diagnostic value of amyloid PET with florbetapir F 18 in addition to the routine clinical diagnostic assessment of patients evaluated for cognitive impairment. DESIGN, SETTING, AND PARTICIPANTS The Incremental Diagnostic Value ofAmyloid PET With [18F]-Florbetapir (INDIA-FBP) Study is a multicenter study involving 18 AD evaluation units from eastern Lombardy, Northern Italy, 228 consecutive adults with cognitive impairmentwere evaluated for AD and other causes of cognitive decline, with a prescan diagnostic confidence of AD between 15%and 85%. Participants underwent routine clinical and instrumental diagnostic assessment. A prescan diagnosiswas made, diagnostic confidencewas estimated, and drug treatmentwas provided. At the time of thisworkup, an amyloid PET/computed tomographic scanwas performed, and the resultwas communicated to physicians afterworkup completion. Physicianswere asked to review the diagnosis, diagnostic confidence, and treatment after the scan. The studywas conducted from August 5, 2013, to December 31, 2014. MAIN OUTCOMES AND MEASURES Primary outcomeswere prescan to postscan changes of diagnosis, diagnostic confidence, and treatment. RESULTS Of the 228 participants, 107 (46%) were male; mean (SD) age was 70.5 (7) years. Diagnostic change occurred in 46 patients (79%) having both a previous diagnosis of AD and an amyloid-negative scan (P < .001) and in 16 (53%) of those with non-AD diagnoses and an amyloid-positive scan (P < .001). Diagnostic confidence in AD diagnosis increased by 15.2%in amyloid-positive (P < .001; effect size Cohen d = 1.04) and decreased by 29.9%in amyloid-negative (P < .001; d = -1.19) scans. Acetylcholinesterase inhibitors and

Compound words in Romance languages may have the head either in the initial or in the final position. In the present event-related potential (ERP) study, we address the hypothesis that Italian compounds are processed differently according to their head position and that this is mostly due to the perceived change in the canonical order of syntactic elements. Compound stimuli (head-initial, head-final, or exocentric) were visually displayed in two presentation modes, as whole words or separated into their constituents, in the context of a lexical decision task. Behavioural results showed an increased split cost in head-final and exocentric compounds as compared to head-initial compounds. ERP results showed an enhanced left anterior negativity (LAN) for head-final and exocentric compounds as compared to head-initial compounds, regardless of the presentation mode. Results suggest that the analogy with syntactic order may influence the internal structure of a compound and, as a consequence, its processing, but other characteristics (such as the grammatical properties of constituents) may affect the processing itself. © 2013 Taylor & Francis.