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R F Allegri

Publications and source records attributed to R F Allegri.

At least 19 recordsLinked to original sources
PubMed2005

A double-blind, randomized clinical trial to assess the augmentation with nimodipine of antidepressant therapy in the treatment of "vascular depression".

BACKGROUND: Cerebrovascular disease may cause "vascular depression" (VaD). Calcium channel-blockers are presumed treatments for cerebrovascular disease and might be expected to improve depression and prevent recurrence. OBJECTIVE: To examine the efficacy and tolerability of the use of nimodipine as an augmentation of fluoxetine in the treatment of VaD. DESIGN: A double-blind, randomized clinical trial in which 101 patients with VaD (Alexopoulos criteria) were treated with fluoxetine at standard doses. Patients were randomized to placebo (n=51) or nimodipine (n=50). Treatment outcomes were assessed using the Hamilton Depression Rating Scale (HDRS) regularly up to 8 months after treatment initiation. RESULTS: Depression was reduced in 63% of patients, but those whose treatment was enhanced with nimodipine had greater improvements overall by repeated measures analysis of covariance (ANCOVA) (F(1.80) = 9.76, p=0.001). In addition, a greater proportion of patients treated with fluoxetine-nimodipine (54% vs. 27%) exhibited full remission (chi2(d.f. 1)= 7.3, p = 0.006), with the number needed to treat (NNT) equal to 4 (95% CI 2-12). Of those experiencing full remission in the first 61 days, fewer patients on fluoxetine-nimodipine (3.7%) developed recurrence of major depression as compared to those on fluoxetine alone (35.7%) (chi2(d.f. 1) = 7.56, p = 0.006), NNT 3 (95% CI 2-9). Side-effects were noted in 33.3% of patients in the control group and 48% of the experimental group (chi2(d.f. 1) = 2.25, p = 0.133). CONCLUSIONS: In treating VaD, augmentation of fluoxetine with nimodipine led to better treatment results and lower rates of recurrence. These findings support the argument that augmentation of antidepressant therapy might be helpful in the treatment of cerebrovascular disease, which is involved in the pathogenesis of this type of depression.

Aged↗
PubMed2002

[Language abnormalities in patients with multiple sclerosis].

BACKGROUND: Patients suffering from multiple sclerosis (MS) have a high frequency of cognitive deficits. Research has demonstrated impairments in memory, attention, information-processing speed, and executive functions. Although it has been traditionally held that language function is commonly preserved in MS, some studies have demonstrated language impairment in these patients, particularly in tasks of naming and word-generation. OBJECTIVES: The aim of the study was to examine language functioning in MS, with particular interest in naming ability and verbal fluency. MATERIAL AND METHODS: Thirty patients with MS, and 30 neurologically intact normal controls, matched for age and educational level were evaluated. As part of a wider neuropsychological evaluation, all subjects were administered the Boston Naming Tests. To compare performances, a comprehensive classification of error types was devised. RESULTS: MS patients showed significantly lower performance on both linguistic measures than the control subjects. On the Boston Naming Test, MS patients obtained significant lower scores than controls, with a high rate of semantic errors. Additionally, they tended to show an also high number of visuoperceptual errors. Low scores on naming task correlated with low performance on verbal fluency. CONCLUSIONS: This study reveals that language function can be impaired in MS, and that naming difficulties are a frequent finding. This naming deficit seems to have a double origin, stemming from disruption at the levels of the perceptual and/or the semantic systems.

Adult↗
PubMed2000

[Spanish verbal fluency. Normative data in Argentina].

Letter and category fluency tasks are used to assess semantic knowledge, retrieval ability, and executive functioning. The original normative data have been obtained mainly from English speaking populations; there are few papers on norms in other languages. The purpose of this study was to collect normative scores in Argentina and to evaluate the effects of sex, age, education and cognitive status on the letter and category fluency tasks, in 266 healthy Spanish-speaking participants (16 to 86 years). Mean education span was 12.8 +/- 4 years. In each subject a neuropsychological battery (Minimental State Exam, Signoret Memory Battery, Boston Naming Test and Trail Making Test) was carried out as well as category fluency (naming animals in one minute) and letter fluency (words beginning with letter "p" in one minute). The sample was arranged into a group of subjects with less than 45 years and further groups up to 10 more years, until 75 years (or more) with three different levels of education. Significant effects were found for age, education, and Minimental State Exam on performance of both fluencies. Mean performance scores are presented for each group to be used in Argentina.

Adolescent↗
PubMed2000

[Executive cognitive alteration of prefrontal type in patients with mesial temporal lobe epilepsy].

This study examines the performance on executive function--classically considered as purported by the frontal lobes--in patients with temporal lobe epilepsy (TLE). Two groups of patients were evaluated: one consisted of 16 TLE patients and the other comprised 12 patients with primary generalised epilepsy (PGE). The Wisconsin Card Sorting Test (WCST) was used as a measure of executive function. Results demonstrated that performance on the WCST was remarkably defective in the TLE group, showing a pattern suggestive of frontal like executive dysfunction in a 75% of the patients, against the 17% of the PGE group (p < 0.001). Impairment was evident when number of categories achieved (p < 0.05), perseverative errors (p < 0.001) and perseverative responses (p < 0.001) were considered. Clinical and theoretical significance of these findings may reflex the executive dysfunction of the mesial temporal lobe region as part of the temporo-frontal circuit.

Adult↗
PubMed1998

[Evaluation of hemispatial dominance by the cancellation test].

Our objective was to study cultural (first language) and innate (handedness) influences on the performance (omissions, site of beginning) of the cancellation test. We studied 71 healthy subjects aged between 18 and 52 years. There were 41 right-handed and 14 left-handed with Spanish as first language in Buenos Aires study site, and 16 right-handed with Hebrew as first language in Israel study site, matched by age and education. We used the Mesulam verbal and non verbal cancellation test, and a modified verbal version in hebrew letters. Omissions in the right side were more frequent in right-handed Spanish-speaking subjects (p < 0.001). We did not find this asymmetry in the individuals from Israel. While all right-handed Spanish-speaking subjects began the test by the left upper corner, most of the left-handed did it by the right upper corner. We conclude that asymmetry in the performance of the cancellation test may have genetic and/or cultural influences.

Adult↗
PubMed1998

[Differential cognitive profiles of fronto-temporal dementia and Alzheimer's disease].

INTRODUCTION AND OBJECTIVE: When the clinical picture consists of prominent cognitive impairments (e.g. amnesia) with relatively mild behavioral symptoms, it can be very difficult to distinguish frontal lobe dementia (FLD) from Alzheimer disease (AD). However, these conditions may have distinct cognitive profiles that could be detected by means of neuropsychological testing. The objective was to examine the early differential cognitive feature between FLD and AD. PATIENTS AND METHODS: Twelve patients with FLD, 20 patients with AD, and 20 normal subjects matched for age and educational level were evaluated with the Folstein Mini Mental State Examination, the Signoret Memory Battery, the Boston Naming Test, Verbal Fluency (FAS), the Wechsler Adult Intelligence Scale, and the Trail Making Test. The FLD patients met the Lund and Manchester criteria, and the AD patients met the National Institute of Neurological Disorders and Stroke-Alzheimer Disease and Related Disorders Association (NINDS-ADRDA) criteria for clinically probable AD. RESULTS: FLD and AD patients were matched for the severity of dementia using the Global Deterioration Scale (3.8 +/- 0.3 versus 3.9 +/- 0.5 respectively). Mean Z scores were calculated in order to facilitate the comparison between the neuropsychological profiles obtained. FLD patients scored significantly better than AD patients in memory test, calculation, visuospatial abilities, and the naming test. AD patients performed better on executive tasks. CONCLUSION: These findings suggest that neuropsychological examination may be useful in differential diagnosis between FLD and AD

Adult↗
PubMed1998

[Memory and dementia].

Memory impairment in ageing is clearly different from Alzheimer's disease. Many papers dealed with the modifications of the different cognitive sections of memory at different stages of Alzheimer's progression: the early involvement of working and episodic memories, those later of semantic and retrograde memories and the lasting saving of implicit memory must be know by clinicians to better understand the target of symptomatic therapy and to differentiate Alzheimer from others degenerative dementias. Above all, these progress authorize an early diagnostic of "possible Alzheimer" at a pre-dementia stage facing to isolated memory complaint. The amnesic profile of others dementias is different and the qualitative approach of testing become essential for the categorization of dementias at early stages with an isolated progressive memory disorder.

Alzheimer Disease↗
PubMed1992

[Neuropsychologic evaluation in Parkinson disease].

For decades Parkinson's disease has been considered to be limited to disturbed motor functions and its association with a cognitive deterioration is very recent. The frequency of cognitive decline varies according to the authors between 3% and 93% depending on the different criteria of evaluation. Owing to the discrepancy among the previous studies our object has been to determine the existence of cognitive changes of statistical significance, since even nowadays the relation between neuropsychology and physiopathology has been misunderstood. A total of 50 patients between 52 and 85 years old with Parkinson's disease have been neurological and neuropsychologically evaluated and the results correlated with 50 healthy controls. Patients, who presented clinical signs of demence according to the criteria of DSM III or any other neurological or general disease were excluded because of possible side effects on the motor cognitive phase. For the neuropsychological study Signoret's Battery of Cognitive Efficiency test (BEC 96) was used, it evaluates: the attention, orientation, thinking, memory, recognition, serial learning, fluency, naming and constructional functions. It was observed that all the patients with Parkinson's disease performed these tests worse than the controls, except for attention. From the statistical point of view the differences are highly significant (p < 0.001) for serial learning and constructional tests and significant (p < 0.05) for orientation, thinking fluency and naming. In the area of mnesic functions the patients with Parkinson's disease show an alteration that predominates significantly on serial learning, however, it is less important for logical memory. All the alterations correspond to the long term memory.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Primarily unilateral herpes encephalitis. Long-term neuropsychological study of 9 cases].

Nine cases of post-herpetic encephalitis with predominant involvement of one temporal lobe at CT scan or MRI (6 on the left and 3 on the right sides) were studied 1 to 6 years after onset with repeated language and memory testing. The neuropsychological findings were well correlated with the lateralization and size of the lesions, as previously observed in unilateral temporal lobectomy. Compared with the usual bilateral form, the sequelae were mild, and all the patients, especially those with right hemisphere involvement, resumed a subnormal family life or social activity. In patients with left predominant lesions the anterograde amnesia concerned verbal information, especially logical and abstract, without visual amnesia. In some cases, the episodic verbal amnesia was associated with a semantic deficit which included the knowledge of some words. In one patient the colour, use and mental imagery of some objects corresponding to forgotten words were involved only for some specific groups (natural objects, whereas man-made objects fared better). Testing of verbal memory is proposed to determine the role of the preserved minor hemisphere in learning the context of word presentation, and words with concrete and visual connections which are better recalled than those with abstract or logical link. Disorders of behaviour or mood are usual in the 2 groups of lesions. Thus, herpes encephalitis in these asymmetrical and benign forms in an attractive model to study the role played by the temporal lobe and lateralization in memory.

Adult↗
PubMedDate not supplied

A double-blind, randomized, fixed-dose trial of fluoxetine vs. amitriptyline in the treatment of major depression complicating Alzheimer's disease.

The objective of this study was to determine the relative efficacy and safety of fluoxetine and amitriptyline in the treatment of major depression complicating Alzheimer's disease (AD). The sample included 37 patients with AD and major depression. The study design was a double-blind, fixed-dose, randomized clinical trial with 45 days of follow-up. The outcome measures were the Hamilton Depression Rating Scale (Ham-D), the Mini-Mental State Exam (MMSE), and the number of dropouts from each arm of the study. Efficacy was similar for fluoxetine and amitriptyline. At Day 45, there was a mean 9.4-point reduction in Ham-D scores (t[df,62] = 9.68, P < 0.0001) and a 2.4-point mean increase in MMSE scores as compared to baseline (t[df,2] = 2.69, P = 0.009). Eleven (58%) of the amitriptyline-treated patients dropped out, compared with 4 (22%) of the fluoxetine-treated patients (chi 2[df,2] = 8.9, P = 0.017). The authors conclude that antidepressant treatment for major depression complicating AD is effective. While fluoxetine and amitriptyline are equally effective, fluoxetine is better tolerated.

Aged↗
PubMedDate not supplied

Vascular dementia: the Latin American perspective.

Population aging is a process that is especially accelerated in some parts of the world. One example is in Latin America. As with other developing regions, Latin America has to confront population "graying" in the context of an emerging economy. As a result of this and of their health history, the prevalence and incidence of age-related pathologies are different than those in the developed world. The burden of dementia is significant for patients, families, health systems, and public health. The aim of this paper was to summarize data from the scarce dementia epidemiological studies available in Latin America, the diagnostic criteria used in most countries and the most widely used diagnostic tools and neuropsychological assessment instruments (some of them translated, validated, and harmonized). Reference is made to the approval process and availability in Argentina of dementia and cognitive decline-related drugs.

Dementia↗
PubMedDate not supplied

[Neuropsychological findings in patients with middle temporal lobe epilepsy].

INTRODUCTION: Cognitive dysfunction in mesial temporal lobe epilepsy (MTLE) is still a controversial subject. Since refractory MTLE is considered a surgically remediable syndrome, the neuropsychological assessment to establish the presence of cognitive impairment in the surgical candidate became an important issue, given its possible relevance in predicting outcome after surgery. OBJECTIVE: Our aim was to study the cognitive profile of MTLE patients and to correlate the cognitive status with the presence or absence of hippocampal sclerosis. PATIENTS AND METHODS: Fifty patients with MTLE and 20 control subjects were matched by age and educational level. All subjects were studied with EEG, MRI scan, SPECT, and a comprehensive neuropsychological battery that included measures of language (naming and verbal fluency), visuospatial function (Block Design Test), memory (Signoret Battery), attention (Digit Span and Trail Making Test A) and executive abilities (Trail Making Test B and Wisconsin Card Sorting Test). RESULTS: MTLE patients, particularly those with hippocampal sclerosis, were found to have a considerable lower performance in learning (p < 0.01), naming (p < 0.05), attention (p < 0.05) and executive functions (p < 0.001). Among the MTLE patients a considerable number of subjects showed results within the normal range (n = 27) while others evidenced laterality specific cognitive impairments (n = 13). Material specific memory effects were seen in some patients but not all. CONCLUSIONS: Our results showed the neuropsychological heterogeneity of temporal lobe epilepsy, thus ruling out the existence of a single specific cognitive pattern of impairment in all MTLE patients, and suggesting the need of a thorough pre-surgical neuropsychological evaluation to be used with post-surgical prognosis purposes.

Adult↗
PubMedDate not supplied

[Attention and neglect: neurological basis, assessment and disorders].

OBJECTIVE: Attention phenomenology is a wide subject, in this revision we will explain attention and its relationship with behavioral neglect. DEVELOPMENT: Selective attention is the ability to throw the focus of awareness toward behaviorally relevant events in the personal and extrapersonal space. Severe alteration of these mechanisms constitutes unilateral neglect in patients with contralateral brain damage. Unilateral neglect is one of the most behaviorally devastating syndrome. There are different behavioral neglect: attentional (perceptual), intentional (motor), motivational and representational aspects of unilateral neglect. Left side neglect after right hemisphere lesions is more common (31 to 46%) than right sided neglect following lesions in the left hemisphere (2 to 12%). CONCLUSION: One year after a cerebrovascular accident only 1/3 of the patients with unilateral neglect persist with this handicap.

Agnosia↗
PubMedDate not supplied

[Relation between patient's subjective complaints and family reports in patients with Alzheimer's type dementia].

INTRODUCTION: Reduced ability to remember facts and events of everyday life is a common complaint in the elderly and is also the first sign of Alzheimer's disease (AD). The present research was designed to study the interrelationship between severity of memory complaints (MC), informant report, and performance in memory tests. MATERIAL AND METHODS: Seventy three (73) patients (41 age associated memory impairment (AAMI), and 32 Alzheimer's disease) and 30 normal controls were studied using the Subjective Memory Questionnaire (modified version), an objective memory battery and the Hamilton depression scale. RESULTS: Age Associated Memory Impairment subjects reported more severe MC (p< 0.001). No relationship was found between severity of MC and age, sex or educational level. Patient's MC didn't correlate with objective memory battery. A strong correlation was found with Hamilton depression score. Caregiver memory reports correlated with objective memory performances. CONCLUSION: Depressive features in AAMI and anosognosia in dementia patients would explain these results. These data suggest that informant report is the best predictor of patient's memory performance.

Aged↗
PubMedDate not supplied

[Prefrontal cortex in memory and attention processes].

INTRODUCTION: The role of the prefrontal cortex still remains poorly understood. Only after 1970, the functions of the frontal lobes have been conceptualized from different points of view (behaviorism, cognitivism). DEVELOPMENT: Recently,different parallel circuits connecting discrete cortical and subcortical regions of the frontal lobes have been described. Three of these circuits are the most relevant to understanding of behavior: the dorsolateral prefrontal circuit, that mediates executive behavior; the orbitofrontal prefrontal circuit, mediating social behavior, and the medial frontal circuit, involved in motivation. Damage to the frontal cortex impairs planning, problem solving, reasoning, concept formation, temporal ordering of stimuli, estimation, attention, memory search, maintaining information in working memory, associative learning,certain forms of skilled motor activities, image generation and manipulation of the spatial properties of a stimulus, metacognitive thinking, and social cognition. Several theories have been proposed to explain the functions of the prefrontal cortex. Currently,the most influential cognitive models are: the Norman and Shallice supervisory attentional system, involved in non-routine selection; the Baddeley working memory model with the central executive as a supervisory controlling system, in which impairment leads to a 'dysexecutive syndrome'; and the Grafman's model of managerial knowledge units, stored as macrostructured information in the frontal cortex. CONCLUSION: The prefrontal cortex is essential for attentional control, manipulation of stored knowledge and modulation of complex actions, cognition, emotion and behavior.

Animals↗
PubMedDate not supplied

[A shortened form of the Spanish Boston naming test: a useful tool for the diagnosis of Alzheimer's disease].

INTRODUCTION: The Boston Naming Test (BNT) is the most frequently used test of confrontation naming. Due to its length, several abbreviated forms have been proposed. OBJECTIVE: The aim of the study was to develop a short form for the Spanish version of the BNT that could detect early semantic changes in Alzheimer s disease (AD). PATIENTS AND METHODS: One hundred and three patients with diagnosis of probable AD (NINCDS ADRDA criteria), with GDS< 5 and 143 normal subjects, matched for age and education, were studied. Subjects with <4 years of education were excluded. No subject had any history of neurological of psychiatric disorders or alcohol abuse. All participants underwent a comprehensive neuropsychological assessment which included the 60 item Spanish version of the BNT. The sensibility and specificity of each item and demographic effect s variability were calculated (ANOVA). Those 12 figures with the highest sensibility and specificity which showed no significant educational or age variation were administered to all participants. The Spearman correlation coefficient was used. RESULTS: Mean score for the control group was 11 (standard deviation: 1.16). No significant effects for age (r= 0.14574) or education (r= 0.101293) were found. The sensibility and specificity for correctly diagnosing AD was 85% and 94% respectively, similar to the longest version. CONCLUSION: This 12 item version of the BNT can be a useful instrument for a rapid screening of AD, as it is as sensible and specific as the 60 item version, and it is not influenced by age or education.

Aged↗
PubMedDate not supplied

[Screening for mild cognitive impairment: usefulness of the 7-Minute Screen Test].

INTRODUCTION: The <<7- Minute Screen>> is a neurocognitive screening test for the detection of Alzheimer's disease (AD) patients in primary care settings. It consists of 4 brief subtests (orientation, memory, visuoconstruction and verbal fluency) and provides a broader neuropsychological profile than other widely used screening tests, The aim of the present study was to study the usefulness of this screening test for the detection of Mild Cognitive Impairment (MCI). METHODS: Thirty-two patients with probable AD (NINCDS-ADRDA criteria), 25 patients with MCI, and 35 healthy control subjects, matched for age and education, underwent a comprehensive neuropsychological battery and the Rio-de-la-Plata version of the 7-Minute Screen. RESULTS. This test showed 93 % sensitivity and 97% specificity in detecting mild-moderate Alzheimer's disease MMSE<24), but it exhibited a substantially decreased sensitivity (28 %) in its ability to detect MCI in AD (MMSE >2 4 ). CONCLUSION: The screening batteries do not replace a m o re compre h e n s i ve neuro psychological assessment. Th ey are useful in detecting patients with mild dementia, but caution must be the rule when considering a diagnosis of MCI.

Aged↗