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Cammisuli D.,University of Pisa | Sportiello M.T.,University of Pisa | Sportiello M.T.,Laboratorio Of Neuropsicologia Clinica | Danti S.,University of Pisa
Giornale di Gerontologia | Year: 2013

Introduction. Few scientific studies have investigated planning deficit in patients suffering from Mild Cognitive Impairment (MCI). Usually, patients with MCI (Amnestic Multiple Domain: Type II) present an impairment of episodic memory and of specific executive functions, such as planning and sensivity to interference. Recent evidences have suggested that such neuropsychological pattern represents one of the main risk factor for the MCI conversion into dementia. Objective. To study planning in patients with MCI and to compare performances of the major MCI subtypes at tests evaluating executive functioning. Methods. 39 patients (Male:Female = 16:23; Age: 74.5±6.3 years; Education: 5.5 ± 2.8 years) with MCI Type I (N = 9) and MCI Type II (N = 30) were assessed by a global cognitive screening, the evaluation of personal and instrumental autonomy, and the specific evaluation of each cognitive domain: memory system, attention system, visual gnosia, constructive praxia, language and executive functioning. In particular, for the executive functioning, the planning abilities (Tower of London -ToL-), the set shifting (Brixton Test, Category Verbal Fluency), the sensivity to interference (Stroop Test), the selective attention (Visual Search Test), and the inhibitory control (Frontal Assessment Battery Go-No-Go Subtest n. 5) have been evaluated. The raw scores were transformed into clusters of Equivalent Scores (ES:0-4) to compare patients' performances. The inferential analysis was performed by the Z-test of Kolmogorov-Smirnov and by the Wilcoxon Test, in order to compare MCI Type I vs MCI Type II, respectively, and the ES clusters within the whole sample, with a significance level of p < 0.05 (Bonferroni-Holm correction). Results. A remarkable deficit of planning has been found for the whole sample, especially for ToL Execution Time (ES = 0:80%). Such a performance is also significantly worse when compared with those of all other tests related to frontal domains (p < 0.005). Conclusion. Future studies should further deeply investigate planning deficit in patients with MCI as one of the most relevant risk factor for the conversion into dementia, along with episodic memory impairment. © Società Italiana di Gerontologia e Geriatria.

Camisuli D.,University of Pisa | Timpano Sportielo M.,University of Pisa | Timpano Sportielo M.,Laboratorio Of Neuropsicologia Clinica | Danti S.,University of Pisa
Giornale di Gerontologia | Year: 2012

Introduction. For the onset of symptomatology, in most patients suffering from Mild Cognitive Impairment (MCI), is a slight impairment of instrumental extramemory functions (language, visual gnosis, constructive praxis), in addition to selective deficits of memory and of executive functioning. Objective. Our study aimed at: 1) describing the impairment of instrumental extra-memory functions in a group of patients suffering from MCI; 2) comparing performances of the major MCI subtypes on the same tests of naming, verbal fluency, visual agnosia, and constructive apraxia; 3) quantifying accuracy of the test used. Methods. The sample was constituted of 162 patients (male 47% vs. female 53%, age 73 ± 7, education 6 ± 3) with a diagnosis of Amnestic MCI single domain (Type I) = n. 43; Amnestic MCI multiple domain (Type II) = n. 101; Non-amnestic MCI single domain (Type III) = n. 9; Non-amnestic MCI multiple domain (Type IV) = n. 3; MCI with atypical profile = n. 6. They were assessed by a wide neuropsychological battery, including: Milan Overall Dementia Assessment; Activities of Daily Living, Instrumental Activities of Daily Living; Digit Span, Corsi Span, Story Recall, Pairs Associates Learning, Corsi Learning Suvra-span, Rivermead Behavioural Memory Test; Visual Search Test, Stroop Color Word Interference Test; Boston Naming Test, Category Fluency Test; Street's Completion Test; Constructive Apraxia Test; Tower of London, Brixton Test, Frontal Assessment Battery n. 5 Go-No-Go subtest. The inferential analysis was made by non-parametric tests (Bonferroni corrected). The discriminant analysis was conducted using a Fisher's linear function (balanced accuracy). Results. 70% of the whole sample showed a moderate cognitive engagement of visual gnosia. 26% of the patients obtained an insufficient performance on the naming task. In particular, Type II had a performance significantly worse than Type I (p = 0.007). 78% of the whole sample showed a moderate cognitive engagement of the ability to produce words following an unusual procedure, that was greater in Type II with a trend toward stastical significance (p = 0.056). Only 2% of the whole sample showed an insufficient performance on Constructive Apraxia Test. For such cognitive ability, the comparison between the major subtypes (Type II vs. Type I) revealed a poorer performance of patients with Amnestic MCI multiple domain than patients with pure amnestic deficit (p = 0.011). A selected set of neuropsychological tests (Pairs Associates Learning, Boston Naming Test, Stroop Color Word Interference Test) (n. = 56) accurately discriminated between Type I and Type II (p = 0.003). Conclusions. Future research should clarify the controversial results related to the impairment of naming and of verbal fluency and deeply study the slght decline of visual gnosia in MCI patients. The set of tests identified by discriminant analysis satisfies the criterion of appropriateness, in order to reduce economic costs arising from assessment time.

Camisuli D.,University of Pisa | Sportielo M.T.,University of Pisa | Sportielo M.T.,Laboratorio Of Neuropsicologia Clinica | Pinori F.,Laboratorio Of Neuropsicologia Clinica | Verdiani C.,Laboratorio Of Neuropsicologia Clinica
Giornale di Gerontologia | Year: 2011

Activation therapy (AT) is a psychological technique of cognitive rehabilitation proposed for patients suffering from mild cognitive impairment and mild dementia. Based on neuropsychological principles, it consists of specific stimulation for each cognitive domain. This approach aims at maximizing cognitive functioning and reducing the risk of decline. It can improve patient's cognitive abilities in daily life activities, alleviating caregiver burden. Objective. To evaluate satisfaction of caregivers after activation therapy. Methods. The pilot-study selected 10 subjects (male 40% vs female 60%, age 81.6 ± 3.64, education level 9.2 ± 5) with diagnosis of mild cognitive impairment (40%) and mild dementia (60%) from outpatients population of Pisa Clinic Neuropsychology Laboratory (Italy). Subjects were assessed with a neuropsychological battery including the investigation of memory, attention, orientation, visual agnosia, constructive apraxia, language and executive functions. Caregiver were administered the Questionnaire for caregiver of Alzheimer disease patient and the Cognitive Burden Inventory. Patients were submitted to 6-month cognitive activation therapy and reassessed at the end of the intervention. Data analysis was done comparing the averages of scores obtained at neuropsychological battery and Cognitive Burden Inventory. Results. Systematic stimulation of cognitive activation generally led to stabilization of patients' cognitive status. cognitive activation therapy can enhance impaired cognitive domains (especially executive functioning and memory), improving patients' abilities in daily life activities. Such treatment is associated with lower scores of burden inventory subscale. Conclusions. The study confirms that cognitive activation therapy can play a critical role in cognitive status of individuals with mild cognitive impairment and mild dementia.

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