Sensitivity of somatic symptoms in post-stroke depression (PSD).
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Depressive Disorder↗
Biomedical subjects
Carlo Caltagirone
Publications and source records attributed to Carlo Caltagirone.
Psychiatric disorders and pain location in unilateral migraineurs.
To explore the relationship between the side of pain during attacks and psychopathological features in strictly unilateral migraine, we recruited 35 patients affected by migraine with and/or without aura diagnosed according to the revised ICHD-II criteria. Seventeen patients had right side-locked pain (R-SUM), 11 had left side-locked (L-SUM) and 7 had side-shifting pain (SSM). Patients were administered the Hamilton Anxiety Scale, the State and Trait Anxiety Inventory-State Anxiety, the Beck Depression Inventory and the 20-item Toronto Alexithymia Scale. Statistical analyses showed that the L-SUM group was significantly more anxious and depressed than the other two groups of patients. Our preliminary data suggest that strictly left unilateral migraine is associated with more severe anxiety and depression. This finding appears to be consistent with studies that reported a higher degree of these disorders in patients with left cerebral hemispheric damage.
Adult↗
Age-related differences in the production of textual descriptions.
Narratives produced by 69 healthy Italian adults were analyzed for age-related changes of microlinguistic, macrolinguistic and informative aspects. The participants were divided into five age groups (20-24, 25-39, 40-59, 60-74, 75-84). One single-picture stimulus and two cartoon sequences were used to elicit three stories per subject. Age-related differences were found with respect to semantic paraphasias, paragrammatisms, syntactic complexity, degree of both local and global coherence, local coherence errors (like ambiguous referencing), and in the level of informativeness conveyed by the stories. The results showed some null effects of age, some effects with a sharp drop in performance in the oldest group, and several effects suggesting a gradual decrease in performance across age groups. No age differences were found with respect to phonological selection and noun-verb ratio. In the proportion of details vs. main themes, the results indicated a possibly better story construction ability in the middle aged (40-59) and young elderly (60-74) groups compared to the younger or the oldest group. Story-type (single picture vs. picture sequence) had a significant influence on some macrolinguistic and informativeness measures.
Adult↗
The role played by the right hemisphere in the organization of complex textual structures.
Eleven patients with right hemisphere damage (RHD), 11 left hemisphere damaged (LHD) nonaphasic subjects, and 11 neurologically intact controls were given three story description tasks. The two brain-damaged groups had no language, visuospatial, memory, or conceptual deficits on standardized neuropsychological testing. In the first experiment, the subjects were asked to retell previously read stories. In the second they had to tell stories which were depicted in cartoon-like fashion. In the third experiment, the story content was also depicted but pictures were given unordered so that the participants had first to arrange them in a plausible sequence. The elicited narratives were analyzed with a method which allowed examining within-sentence (lexical selection and syntactic complexity) and between-sentence (cohesion and coherence) processing abilities of the three groups. In the first experiment all groups performed quite well on both within- and between-sentence measures. In the two picture description tasks, however, the performances of the right hemisphere damaged subjects were poorer than those of normal controls when examined in terms of information content or coherent and cohesive aspects of narrative production. These findings agree with the hypothesis that RHD subjects are impaired in deriving from visual information the mental model of a story. They also indicate that clinical methods for analyzing structural aspects of discourse are suitable to identify these symptoms.
Aged↗
Plasma dehydroepiandrosterone levels are strongly increased in schizophrenia.
Dehydroepiandrosterone has been recently recognized as neuroactive steroid with several vital neurophysiological activities on membrane receptors, such as N-methyl-d-aspartate, and gamma-aminobutyric acid receptors and on genomic androgen receptors. DHEA does also have an antiglucocorticoid effect. So far, the relevance of this neuroactive steroid to psychiatric disorders is not well known. In this study, plasma levels of DHEA were determined with a highly sensitive and specific gas-chromatography/mass-spectrometry method in 23 outpatients suffering from Diagnostic and Statistical Manual of Mental Disorders-IV schizophrenia compared with 23 healthy control subjects matched for age and sex. Plasma levels of DHEA were found to be strongly elevated in the group of schizophrenic patients (mean+/-SD=90.9+/-61.4 nmol/l) compared to that of control subjects (mean+/-SD=24.0+/-17.9 nmol/l) and the difference was highly significant (t=5.018, df=44, p<0.0001). This statistically significant difference was also found when we divided the groups of schizophrenics and controls in subgroups of males (t=4.536, df=24, p=0.0001) and females (t=2.777, df=18, p=0.0124). These results suggest that DHEA may have some role in the pathophysiology of schizophrenia due to its complex mechanism of action in the brain involving genomic and non-genomic components. Therefore, its study may provide further understanding of the pathophysiology of psychoses and open new avenues for their treatment.
Adolescent↗
Changes in white matter in long-term survivors of severe non-missile traumatic brain injury: a computational analysis of magnetic resonance images.
The aim of this study was to investigate long-term consequences of severe non-missile traumatic brain injury (nmTBI) in patients without macroscopic focal brain lesions (>1.6 cm(3)) on regional white-matter density (WMd), and possible correlations with days of coma and memory performances. T1-weighted magnetic-resonance images (MRI) were acquired in 19 nmTBI patients, 3-113 months following the injury, and in 19 control subjects matched for age and gender. In addition, nmTBI patients underwent a battery of standardised memory tests. The MRIs were processed in a fully automatic system using voxel-by-voxel methods. Corpus callosum, fornix, anterior limb of the internal capsule, superior frontal gyrus, para-hippocampal gyrus, optic radiation and chiasma showed significant WMd reduction in nmTBI when compared to control subjects. None of the correlations between days of coma and memory performance scores with nmTBI voxels value that showed WMd reduction reached significance, with the exception of a significant negative correlation between WMd in the mid body of corpus callosum and short-story delayed recall. We detected reductions in WM density in several brain locations similar to those described in previous post mortem investigations. In addition, we observed WMd reduction in the optic chiasma and in the optic radiations; this finding may reflect transneural degeneration along the visual pathway. The weak correlations between specific anatomical sites of the reduced WMd and behavior may reflect the diffuse nature of the brain damage and/or the different time of onset between behavioral manifestations and neuropathological modifications occurring in nmTBI.
Adolescent↗
Symptom profile of DSM-IV major and minor depressive disorders in first-ever stroke patients.
OBJECTIVE: Depressive disorders are very common in stroke patients. However, vegetative and cognitive symptoms primarily derived from brain damage could hypothetically be indistinguishable from those directly derived from neuropsychiatric disorders, and this could invalidate the diagnostic assessment. Thus, authors aimed to detect the frequency of clinically-rated DSM-IV depressive symptoms and the diagnostic validity of depressive disorders in stroke patients suffering from major depressive disorder (MDD), minor depressive disorder (MIND), and those free of any neuropsychiatric disorders (NODEP). METHODS: First-ever stroke patients (N=200) were approached within 3 months of the acute stroke and were interviewed with the SCID-P and administered the Hamilton Rating Scale for Depression (Ham-D), the Beck Depression Inventory (BDI), the Barthel Index, and the Mini-Mental State Exam. RESULTS: Fifty patients (25%) had MDD, 62 (31%) had MIND, and 88 (44%) had NODEP. Global cognitive level, functional impairment, total scores, and psychic and somatic subscores of the Ham-D and the BDI were different among the three groups. The only symptom that did not differ among patients with MDD, MIND, and NODEP was Feelings of Guilt; all the other eight DSM-IV symptoms were significantly different. In particular, the frequency of Depressed Mood, Diminished Interest or Pleasure, Fatigue or Loss of Energy, Insomnia, and Psychomotor Agitation/Retardation was higher in MIND patients than in NODEP patients. CONCLUSIONS: During the diagnostic procedure for depressive disorders in stroke patients, clinicians should consider equally important vegetative, cognitive, and psychological depressive symptoms, despite their nature.
Aged↗
Guidelines for the treatment of Alzheimer's disease from the Italian Association of Psychogeriatrics.
A committee of experts from the Italian Association of Psychogeriatrics compiled the following report, which was then approved by a Steering Committee (comprising 20 specialists in neurology, psychiatry or geriatrics) from the Association and by two Alzheimer associations representing patients and families: the Italian Association for Alzheimer's Disease and the Italian Federation for Alzheimer's Disease. The report is based on a comprehensive review of the scientific literature on the treatment of Alzheimer's disease, discusses methodological aspects of dementia management, and details the limitations of current therapies. These guidelines are, in general, consistent with the principles of evidence-based medicine; however, for some controversial or poorly investigated issues, the guidelines integrate scientific evidence with experience and opinions from experts working in the clinical setting. In particular, the clinical experience of experts has been used to define recommendations for starting and interrupting pharmacotherapy, and to critically review evidence about the efficacy of non-pharmacological interventions. The principal pharmacotherapeutic interventions covered in the guidelines are acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine, and tacrine) and memantine. The main non-pharmacological interventions reviewed are memory training, reality orientation therapy, and combined non-pharmacological interventions. Other issues covered are opportunities for Alzheimer's disease prevention, various modalities of care, and the treatment of comorbidities.
Aged↗
Preliminary evidence for an association between aggressive and hostile behaviour and 3alpha,5alpha-tetrahydroprogesterone plasma levels in schizophrenia.
OBJECTIVE: Because it has been suggested that agents acting on the gamma-aminobutyric acid-A (GABA(A)) receptor complex, such as the neuroactive steroid 3!#!alpha;,5alpha-tetrahydroprogesterone (3alpha,5alpha-THP), may be biologic modulators of aggression, we aimed to measure 3alpha,5alpha-THP plasma concentrations in subjects with schizophrenia in order to investigate a possible relation with aggressive and hostile behaviour. METHODS: Eight outpatients with schizophrenia diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), were included. Aggression and hostility were assessed using the Modified Overt Aggression Scale and the paranoid/belligerence symptom cluster of the Positive and Negative Syndrome Scale. Plasma samples were obtained 1 hour before psychometric assessment and were quantified for 3alpha,5alpha-THP using a highly sensitive and specific combined analysis by gas chromatography-mass spectrometry. RESULTS: Increased aggressiveness and hostility were associated with increased 3alpha,5alpha-THP plasma levels (Pearson r = 0.72, p = 0.043 and Pearson r = 0.72, p = 0.041, respectively). CONCLUSIONS: These preliminary results suggest that the neuroactive steroid 3alpha,5alpha-THP may affect aggression and hostility in humans.
Adult↗
[Variability of efficacy measures in Alzheimer's disease].
The efficacy of medical interventions is their capacity of inducing positive modifications of the natural history of diseases. The natural history of dementia is marked by specific events related to the cognitive and functional decline, but their occurrence is poorly predictable in individual patients being highly variable from patient to patient. For this reason it is difficult that the modest efficacy of available interventions for dementia, or their entity measured by clinical scales, may be perceived in clinical practice or in observational studies. Moreover in randomized clinical studies, the effect of this variability, in analogy to misclassification of exposition and/or disease in case control or cohort epidemiological studies, is that of an underestimation of the true efficacy of interventions.
Alzheimer Disease↗
Memory for time intervals is impaired in left hemi-Parkinson patients.
The basal ganglia have been proposed as one of the neural correlates of timekeeping functions. Both encoding and memory retrieval components for time perception are impaired in Parkinson's disease (PD). The aim of our study was to investigate in hemi-Parkinsonian patients the existence of a specific alteration in memory for time depending on the affected side, to better understand the contribution of the left or right basal ganglia circuits in different components of time perception. Right and left hemi-PD patients performed a time reproduction task in which they were required to reproduce in the same session short (5 s) and long (15 s) time intervals, in off- and on-therapy condition. While the right hemi-PD patients overestimated the shorter interval, only the left hemi-PD group showed the memory migration effect, overestimating the shorter and underestimating the longer time intervals. These results argue for a critical involvement of the right basal ganglia in memory retrieval for time intervals, in the range of seconds.
Aged↗
Increased facilitation of the primary motor cortex following 1 Hz repetitive transcranial magnetic stimulation of the contralateral cerebellum in normal humans.
Connections between the cerebellum and the contralateral motor cortex are dense and important, but their physiological significance is difficult to measure in humans. We have studied a group of 10 healthy subjects to test whether a modulation of the excitability of the left cerebellum can affect the excitability of the contralateral motor cortex. We used repetitive transcranial magnetic stimulation (rTMS) at 1 Hz frequency to transiently depress the excitability of the left cerebellar cortex and paired-pulse TMS testing of intracortical inhibition (ICI) and intracortical facilitation (ICF) to probe the excitability of cortico-cortical connections in the right motor cortex. The cortical silent period was also measured before and after cerebellar rTMS. Motor evoked potentials (MEPs) were significantly larger after than before conditioning rTMS trains (p < 0.01). Moreover, left cerebellar rTMS increased the ICF of the right motor cortex as measured with paired-pulses separated by an interstimulus interval (ISI) of 15 ms. The effect lasted for up to 30 min afterward and was specific for the contralateral (right) motor cortex. The cortical silent period was unaffected by cerebellar rTMS. The implication is that rTMS of the cerebellar cortex can shape the flowing of inhibition from Purkinje cells toward deep nuclei, thereby increasing the excitability of interconnected brain areas.
Adult↗
Modulation of excitatory and inhibitory circuits for visual awareness in the human right parietal cortex.
The balance of specific patterns of excitation and inhibition in critical regions of both hemispheres could be relevant in orienting attention over the extrapersonal space. In the present study a group of normal subjects had to detect small rectangular stimuli presented briefly on a computer screen in three different conditions: unilateral presentation either to left or right visual periphery or bilateral simultaneous presentation. Paired transcranial magnetic stimulation (TMS), was applied over the right parietal cortex 150 ms after the presentation of the visual stimuli with different inter-stimulus intervals (ISIs: 1, 3,5 and 10 ms). When paired TMS was applied 150 ms, but not 100 ms, after simultaneous visual presentation, the number of failures in detecting left targets increased compared to the single-pulse condition if the ISI was 3 ms; on the contrary, it decreased if the ISI was 5 ms. No effects were seen when paired pulses of the same intensity were delivered. These findings provide evidence of a supramodal-specific pattern of excitability of the right posterior parietal cortex in processing visuospatial information.
Adult↗
Global cognitive level and antidepressant efficacy in post-stroke depression.
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Aged↗
Cardiac autonomic derangement and arrhythmias in right-sided stroke with insular involvement.
BACKGROUND AND PURPOSE: The insula of the right cerebral hemisphere may have a major role in cardiac autonomic control. This study was aimed at assessing the effects of acute right insular ischemic damage on heart rate variability (HRV) and arrhythmias. METHODS: Holter monitoring for 24 hours was performed in 103 consecutive patients with first-ever acute ischemic stroke. Time and frequency domain measures of HRV and arrhythmias were considered in all cases. RESULTS: Forty-nine patients (47.5%) had a right-sided infarction, whereas 54 (52.5%) had a left-sided infarction. Insular involvement was present in 33 patients with right-sided stroke (67.3%) and in 36 patients with left-sided stroke (66.6%). When compared with all other stroke patients, subjects with right-sided insular damage showed significantly lower values of the standard deviation of all normal-to-normal (SDNN) R wave to R wave (RR) intervals and of the root mean square of differences (rMSSD) of adjacent normal-to-normal RR intervals, and higher low-frequency/high-frequency ratio values (P<0.05). Right insular stroke was also associated with more complex arrhythmias than any other localization (P<0.05). Moreover, in the whole population of stroke patients, lower values of SDNN were associated with the presence of more frequent and complex arrhythmias. CONCLUSIONS: These findings further support the notion that the right insula is implicated in the autonomic control of cardiac activity and that acute right insular damage may lead to a derangement of cardiac function with potential prognostic implications.
Aged↗
Subthalamic deep brain stimulation improves time perception in Parkinson's disease.
Alterations in temporal estimation have been observed in Parkinson's disease (PD) and have been associated with dopaminergic dysfunction. To investigate whether deep brain stimulation might reverse these abnormalities in PD, patients treated with electrode implantation for subthalamic deep brain stimulation were required to reproduce time intervals in different experimental conditions (off deep brain stimulation/off therapy, on deep brain stimulation/off therapy, on therapy/off deep brain stimulation). Patients treated with deep brain stimulation in off deep brain stimulation/off therapy displayed the anomalous pattern of responses typically observed in PD. When subthalamic deep brain stimulation was turned on these abnormalities were significantly attenuated. Our findings reveal that subthalamic deep brain stimulation improves time perception in PD patients, supporting the critical role of basal ganglia in this cognitive function, probably mediated by facilitated thalamo-cortical projections to the prefrontal cortex.
Aged↗
Amnesia following endoscopic third ventriculostomy: a single case study.
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Adult↗
Mutations of the Nogo-66 receptor (RTN4R) gene in schizophrenia.
Schizophrenia (SCZD) or schizoaffective disorders are quite common features in patients with DiGeorge/velo-cardio-facial syndrome (DGS/VCFS) as a result of chromosome 22q11.2 aploinsufficiency. We evaluated the Nogo-66 receptor gene (RTN4R), which maps within the DGS/VCFS critical region, as a potential candidate for schizophrenia susceptibility. RTN4R encodes for a functional cell surface receptor, a glycosylphosphatidylinositol (GPI)-linked protein, with multiple leucine-rich repeats (LRR), which is implicated in axonal growth inhibition. One hundred and twenty unrelated Italian schizophrenic patients were screened for mutations in the RTN4R gene using denaturing high performance liquid chromatography (DHPLC). Three mutant alleles were detected, including two missense changes (c.355C>T; R119W and c.587G>A; R196H), and one synonymous codon variant (c.54G>A; L18L). The two schizophrenic patients with the missense changes were strongly resistant to the neuroleptic treatment at any dosage. Both missense changes were absent in 300 control subjects. Molecular modeling revealed that both changes lead to putative structural alterations of the native protein.
Adult↗