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Elena Fiabane,1 Federica Scarpina,2,3 Marcella Ottonello,4 Caterina Pistarini5 1Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Pavia Institute, Pavia, Italy; 2Rita Levi Montalcini” Department of Neurosciences, University of Turin, Turin, Italy; 3Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, Piancavallo, VCO, Italy; 4Istituti Clinici Scientifici Maugeri IRCCS, Department of Physical and Rehabilitation Medicine of Pavia Institute, Pavia, Italy; 5Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurorehabilitation of Pavia Institute, Pavia, ItalyCorrespondence: Marcella Ottonello, ICS Maugeri Spa SB, via Missolungi 14, Genova, 16167, Italy, Tel +0039 01030791251, Email marcella.ottonello@icsmaugeri.itPurpose: In this study, we evaluated changes in attentional capabilities and reasoning among early abstinent alcohol-dependent individuals after a 28-day residential rehabilitation program (not including cognitive treatment). Furthermore, we explored the role of individual characteristics and disease-related factors (i.e., length of alcohol use, history of polysubstance dependence, severity of alcohol use) on spontaneous cognitive recovery.Patients and Methods: Fifty-five patients with a diagnosis of Alcohol Use Disorder (AUD) were consecutively recruited from a residential rehabilitation hospital in Northern Italy. The majority were male (67.3%) with a mean age of 47.83 years (SD = 8.21). The computerized Psychology Experiment Building Language Test Battery was used to assess the performance at the Posner Cueing Test, Go/no-go Task, Trail Making Test (TMT), Tower of London (TOL), and Balloon Analog Risk Scale. The evaluation was performed twice: at the beginning (T0) and at its end (T1, before the hospital discharge).Results: We observed statistically improvements over time in the performance at the: 1) TOL in the time amount required to solve the task (p < 0.001); and 2) TMT in the index

Background: Cognitive dysfunctions, both subjective and detectable at psychometric testing, may follow SARS-CoV-2 infection. However, the ecological-functional relevance of such objective deficits is currently under-investigated. This study thus aimed at investigating the association between objective cognitive measures and both physical and cognitive, ecological-functional outcomes in post-COVID-19. Methods: Forty-two COVID-19-recovered individuals were administered the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The Functional Independence Measure (FIM) was adopted to assess functional-ecological, motor/physical (FIM-Motor) and cognitive (FIM-Cognitive) outcomes at admission (T0) and discharge (T1). Results: When predicting both T0/T1 FIM-total and-Motor scores based on MMSE/MoCA scores, premorbid risk for cognitive decline (RCD) and disease-related features, no model yielded a significant fit. However, the MoCA - but not the MMSE significantly predicted T0/T1 FIM-Cognitive scores. The MoCA was significantly related only to T0/T1 FIM-Cognitive Memory items. Discussion: Cognitive measures are not associated with physical/motor everyday-life outcomes in post-COVID-19 patients. The MoCA may provide an ecological estimate of cognitive functioning in this population.

Background: Episodic long-term memory (LTM) difficulties/deficits are frequent in COVID-19-recovered patients and negatively impact on prognosis and outcome. However, little is known about their semiology and prevalence, also being still debated whether they arise from primary amnesic features or are secondary to dysexecutive/inattentive processes and disease-related/premorbid status. Hence, this study aimed at (1) assessing LTM functioning in post-infectious SARS-CoV-2 patients by accounting for premorbid and disease-related confounders and (2) exploring its cognitive etiology. Methods: Measures of global cognition (Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA)) and LTM (Babcock Memory Test (BMT)) of fifty-four COVID-19-recovered patients were retrospectively collected. Patients were subdivided into those being already at risk or not for cognitive decline (RCD + ; RCD −). Cognitive measures were converted into equivalent scores (ESs). Results: LTM sub-clinical/clinical deficits (ESs = 0/1) were mildly-to-moderately prevalent in both RCD + (MoCA-Memory, 31.8%; BMT, 31.8%) and RCD − (MoCA-Memory, 28.6%; BMT, 39.3%) patients. MMSE and MoCA total scores, but not the MoCA-Attention subtest, were associated with the BMT. RCD + asymptomatic patients performed better on the BMT (p =.033) than those requiring O2 therapy (but not ventilation). Discussion: COVID-19-recovered individuals might show LTM deficits of both primary and secondary etiology and should be thus screened for them, especially those having suffered mid-to-moderate COVID-19 and those already being at risk for cognitive decline. Both I- and II-level measures of verbal LTM can be adopted, although the former might be more sensitive.

Background: The novel human coronavirus (SARS-CoV-2) shows neurotropism and systemically affects the central nervous system (CNS). Cognitive deficits have been indeed reported as both short- and long-term sequelae of SARS-CoV-2 infection. However, the association between these disturbances and background/disease-related clinical features remains elusive. This work aimed at exploring how post-infective cognitive status relates to clinical/treatment outcomes by controlling for premorbid/current risk factors for cognitive deficits. Methods: Cognitive measures (Mini-Mental State Examination, MMSE) of N=152 COVID-19 patient were retrospectively assessed in relation to disease severity, intensive care unit (ICU) admission, steroidal treatment, and occurrence of other viral/bacterial infections by controlling for remote/recent/COVID-19-related risk factors for cognitive deficits (at-risk vs. not-at-risk: Neuro+ vs. Neuro−). Results: Descriptively, impaired MMSE performances were highly prevalent in mild-to-moderate patients (26.3%). ICU-admitted patients made less errors (p=.021) on the MMSE than those not admitted when partialling out risk factors and age—the latter negatively influencing performances. When addressing Neuro− patients only, steroidal treatment appears to improve MMSE scores among those suffering from other infections (p=.025). Discussion: Cognitive sequelae of COVID-19 are likely to arise from a complex interplay between background/clinical premorbid features and disease-related/interventional procedures and outcomes. Mild-to-moderate patients requiring assistive ventilation who however are not admitted to an ICU are more likely to suffer from cognitive deficits—despite their etiology remaining elusive.

Background: Due to SARS-CoV-2-related encephalopathic features, COVID-19 patients may show cognitive sequelae that negatively affect functional outcomes. However, although cognitive screening has been recommended in recovered individuals, little is known about which instruments are suitable to this scope by also accounting for clinical status. This study thus aimed at comparatively assessing the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) in detecting cognitive deficits in post-COVID-19 patients premorbidly/contextually being or not at risk for cognitive deficits (RCD + ; RCD-). Methods: Data from N = 100 COVID-19-recovered individuals having been administered both the MMSE and the MoCA were retrospectively analyzed separately for each group. RCD ± classification was performed by taking into consideration both previous and disease-related conditions. Equivalent scores (ESs) were adopted to examine classification performances of the two screeners. Results: The two groups were comparable as for most background and cognitive measures. MMSE or MoCA adjusted scores were mostly unrelated to disease-related features. The two screeners yielded similar estimates of below-cut-off performances—RCD + : MMSE: 20%, MoCA: 23.6%; RCD-: MMSE: 2.2%, MoCA: 4.4%. However, agreement rates dropped when also addressing borderline, “low-end” normal, and normal ability categories—with the MoCA attributing lower levels than the MMSE (RCD + : Cohen’s k =.47; RCD-: Cohen’s k =.17). Discussion: Although both the MMSE and the MoCA proved to be equally able to detect severe cognitive sequelae of SARS-CoV-2 infection in both RCD + and RCD- patients, the MoCA appeared to be able to reveal sub-clinical defects and more sharply discriminate between different levels of ability.

Stefano Caneva,1 Marcella Ottonello,1 Elisa Torselli,1,2 Caterina Pistarini,3 Paola Spigno,1 Elena Fiabane1,4 1Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, Italy; 2Miller Institute for Behavioral and Cognitive Therapy, Genoa, Italy; 3Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Scientific Institute of Pavia, Genoa, Italy; 4Department of Brain and Behavioral Sciences, University of Pavia, Pavia, ItalyCorrespondence: Caterina PistariniDepartment of Physical & Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Pavia, Via Maugeri 4, Pavia, Genoa 27100, ItalyTel +39 010 30791250Fax +39 010 3079 1269Email caterina.pistarini@icsmaugeri.itPurpose: Cognitive impairment is common among patients with alcohol use disorder (AUD). However, neuropsychological assessment is not usually included as routine practice in alcohol rehabilitation programs. The aim of this study was to describe qualitatively the cognitive deficits in early-detoxified AUD patients undergoing rehabilitation and to explore relevant associations with socio-demographic, clinical and psychological factors.Patients and Methods: Forty-one patients with a diagnosis of AUD were consecutively recruited from a residential rehabilitation hospital in Northern Italy. Cognitive impairment was assessed using the Brief Neuropsychological Examination 2 (ENB-2). Anxiety, depression and severity of alcohol dependence were also evaluated using validated self-report questionnaires. Alcohol relapse was investigated 1 month after discharge.Results: Overall, 31.7% of AUD patients showed cognitive impairments according to the global score scale. However, 70.7% had an impaired performance on at least one test of the ENB-2, with particular regard to executive function, visuospatial and memory domains. Age, education and abstinence at admission were the most relevant factors associated with cognitive deficits in this clinical populatio

M Ottonello,1 E Fiabane,1 C Pistarini,2 P Spigno,1 E Torselli3 1Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Genoa, Italy; 2Department of Physical and Rehabilitation Medicine, ICS Maugeri SPA SB, Pavia, Italy; 3Miller Institute for Behavioral and Cognitive Therapy, Genoa, ItalyCorrespondence: C PistariniIstituti Clinici Scientifici Maugeri IRCCS, Via Maugeri 4, Pavia 27100, ItaliaTel +3901030791250Email caterina.pistarini@icsmaugeri.itPurpose: Understanding how difficulties in emotion regulation can be related to metacognitive beliefs during early abstinence, identifying which factors are associated with craving and relapse risk may be useful in residential rehabilitation treatment of alcohol addiction.Methods: Sixty-five patients underwent a 28-day rehabilitation program for alcohol addiction. They underwent a brief semi-structured interview at admission and completed a battery of five self-report questionnaires between days 7 and 10 of alcohol abstinence (T0) and 3 days prior to discharge (T1).Results: After rehabilitation program, all symptoms of psychological distress decreased. We found a significant improvement in all emotional, cognitive and metacognitive scales except for “Cognitive harm” (NAM), “Awareness” (DERS) and a small effect size (low statistical power) for “Emotional clarity” (DERS). Compared to those still abstinent at 1 month from discharge, we found more difficulties in “Emotional clarity” in those who had an early relapse. Difficulties in “Emotional clarity” were observed also in patients with a high level of craving at discharge.Conclusion: Significant differences were observed between the groups “abstinence vs non-abstinence” at 1 month from discharge concerning difficulties in emotion regulation. In particular, we found difficulty in the awareness and understanding of emotion, precisely to identify

Elisa Torselli,1 Marcella Ottonello,2 Emilio Franceschina,1 Emanuele Palagi,1 Giorgio Bertolotti,3 Elena Fiabane2,4 1Miller Institute for Behavioral and Cognitive Therapy, Genoa, Italy; 2Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, Italy; 3Psychology Unit, ICS Maugeri SPA SB, IRCCS, Tradate, Italy; 4Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy Purpose: The aims of this pilot study were to examine cognitive factors (brooding and craving) together with positive/negative metacognitive beliefs about alcohol during a residential program for alcohol addiction and to explore relationships with psychological variables at discharge, with the scope of identifying predictive factors of psychological outcome and patients at greatest risk of relapse. Methods: Thirty patients underwent a brief semistructured interview on admission to a 28-day rehabilitation program for alcohol addiction, and completed at admission and discharge the following five self-report questionnaires: 1) brooding (Brooding subscale of Ruminative Response Scale [B-RRS]), 2) craving (Penn Alcohol Craving Scale [PACS]), 3) positive beliefs about alcohol use (Positive Alcohol Metacognitions Scale [PAMS]), 4) negative beliefs about alcohol use (Negative Alcohol Metacognitions Scale [NAMS]), and 5) the psychophysical state of health (Cognitive Behavioral Assessment – Outcome Evaluation [CBA-OE]). Results: Significant changes were found between admission and discharge in CBA-OE, B-RRS, and PACS. Brooding at admission was a significant predictor of post-treatment psychological variables of “anxiety”, “depression”, and “psychological distress”, whereas craving at admission was a good predictor of “perception of positive change” at discharge. Conclusion: Our results confirm the importance of brooding in mood regulation and its role in t

Elena Fiabane,1,2 Marcella Ottonello,1,3 Valeria Zavan,4 Caterina Pistarini,1 Ines Giorgi5 1Department of Physical and Rehabilitation Medicine, ICS Maugeri Spa SB, Institute of Genoa Nervi, Genoa, 2Department of Brain and Behavioral Sciences, University of Pavia, Pavia, 3Department of Medicine, PhD Program in Advance Sciences and Technologies in Rehabilitation Medicine and Sport, Università di Tor Vergata, Rome, 4Alcohol Unit, Addiction Department, Alessandria, 5Psychology Unit, ICS Maugeri Spa SB, Scientific Institute of Pavia, Pavia, Italy Background: An inpatient 28-day rehabilitation program for alcohol dependence is focused on detoxification, enhancing motivation to change, and coping strategies for the management of emotional distress and temptation to drink. The aims of the present study were to investigate 1) changes over time in motivation to change, anxiety, and depression in individuals undergoing residential rehabilitation treatment for alcohol addiction, and 2) which pretreatment factors are associated with posttreatment temptation to drink.Methods: We assessed 432 patients diagnosed with alcohol dependence based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) consecutively recruited from seven residential rehabilitation centers in Northern Italy. Patients were assessed by means of self-report questionnaires at the beginning of rehabilitation (pretreatment) and before their hospital discharge (posttreatment) regarding motivation to change and self-efficacy (motivation assessment of change – alcoholism version), readiness to change and temptation to drink (visual analog scales), and depression and anxiety (cognitive behavioral assessment – outcome evaluation).Results: Results showed an overall improvement in motivation to change and a significant reduction over time in depression and anxiety levels for the total sample, particularly patients with low baseline level of temptation

Ines Giorgi,1 Marcella Ottonello,2,3 Giovanni Vittadini,4 Giorgio Bertolotti5 1Psychology Unit, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Pavia, 2Department of Physical & Rehabilitation Medicine, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Genoa, 3Department of Medicine, PhD Program in Advanced Sciences and Technologies in Rehabilitation Medicine and Sport, Università di Tor Vergata, Rome, 4Alcohol Rehabilitation Unit, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Pavia, 5Psychology Unit, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Tradate, Italy Background: Alcohol-dependent patients usually experience negative affects under the influence of alcohol, and these affective symptoms have been shown to decrease as a result of alcohol-withdrawal treatment. A recent cognitive–affective model suggests an interaction between drug motivation and affective symptoms. The aim of this multicenter study was to evaluate the psychological changes in subjects undergoing a residential rehabilitation program specifically designed for alcohol addiction, and to identify at discharge patients with greater affective symptoms and therefore more at risk of relapse.Materials and methods: The sample included 560 subjects (mean age 46.91±10.2 years) who completed 28-day rehabilitation programs for alcohol addiction, following a tailored routine characterized by short duration and high intensity of medical and psychotherapeutic treatment. The psychological clinical profiles of anxiety, depression, psychological distress, psychological well-being, and self-perception of a positive change were assessed using the Cognitive Behavioral Assessment – Outcome Evaluation questionnaire at the beginning and at the end of the program. The changes in the psychological variables of the questionnaire were iden