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Angelillo V.G.,The Second University of Naples | Lucia N.D.,The Second University of Naples | Trojano L.,The Second University of Naples | Trojano L.,Scientific Institute of Telese Terme BN | Grossi D.,The Second University of Naples
Brain and Language

Mirror writing (MW) is a rare disorder in which a script runs in direction opposite to normal and individual letters are reversed. The disorder generally occurs after left-hemisphere lesions, is transient and is observed on the left hand, whereas usually motor impairments prevent assessment of direction of right handwriting. We describe a left-handed patient with complete left hand mirror writing, still evident 2 years after a hemorrhagic stroke in left nucleo-capsular region. Since the patient could write with his right hand he underwent several writing tasks with either hand, and a thorough assessment to clarify the nature of MW. MW was evident in writing to dictation with left hand only, both in right and left hemispace, but the patient could modify his behavior when a verbal instruction was provided. No mirror errors were found in reading words, in copying geometric figures and in spatial orientation tasks. MW in our patient could be accounted for by a failure in automatic transformation of grapho-motor programs to write with the left hand. A lack of concern (a sort of anosodiaphoria) and a poor cognitive flexibility could contribute to long-term persistence of MW. © 2010 Elsevier Inc. Source

Trojano L.,The Second University of Naples | Trojano L.,Scientific Institute of Telese Terme BN | Gainotti G.,Catholic University
Journal of Alzheimer's Disease

Drawing is a multicomponential process that can be impaired by many kinds of brain lesions. Drawing disorders are very common in Alzheimer's disease and other forms of dementia, and can provide clinical information for the distinction of the different dementing diseases. In our review we started from an overview of the neural and cognitive bases of drawing, and from a recollection of the drawing tasks more frequently used for assessing individuals with dementia. Then, we analyzed drawing disorders in dementia, paying special attention to those observed in Alzheimer's disease, from the prodromal stages of the amnesic mild cognitive impairment to the stages of full-blown dementia, both in the sporadic forms with late onset in the entorhino-hippocampal structures and in those with early onset in the posterior neocortical structures. We reviewed the drawing features that could differentiate Alzheimer's disease from vascular dementia and from the most frequent forms of degenerative dementia, namely frontotemporal dementia and Lewy body disease. Finally, we examined some peculiar aspects of drawing disorders in dementia, such as perseverations, rotations, and closing-in. We argue that a careful analysis of drawing errors helps to differentiate the different forms of dementia more than overall accuracy in drawing. Source

Dubbioso R.,University of Naples Federico II | Moretta P.,Scientific Institute of Telese Terme BN | Manganelli F.,University of Naples Federico II | Fiorillo C.,Molecular Medicine | And 3 more authors.
Journal of Neurology

Oculopharyngeal muscular dystrophy (OPMD) is an autosomal dominant disorder caused by a small expansion of a short polyalanine tract in poly(A) binding protein nuclear 1 (PABPN1). It presents with adult onset of progressive eyelid drooping, swallowing difficulties and proximal limb weakness, usually without involvement of central nervous system (CNS). However, cognitive decline with relevant behavioural and psychological symptoms has been recently described in homozygous patients. In this study, we performed for the first time an extensive neuropsychological and neuropsychiatric evaluation on 11 OPMD heterozygote patients. We found that they were less efficient than a matched control sample on several tests, particularly those tapping executive functions. Moreover, the presence of negative correlation between GCN expansion size and some neuropsychological scores raises the issue that CNS involvement might be linked to the genetic defect, being worse in patients with larger expansion. Our results might be consistent with the toxic gain-of-function theory in the pathogenesis of OPMD and hint at a possible direct role of PABPN1 in the CNS also in heterozygote patients. © Springer-Verlag 2011. Source

Grossi D.,The Second University of Naples | De Lucia N.,The Second University of Naples | Trojano L.,The Second University of Naples | Trojano L.,Scientific Institute of Telese Terme BN
Journal of Alzheimer's Disease

Background: Apathy and depression are behavioral manifestations that may occur often in Alzheimer's disease (AD) patients. AD patients may also show Closing-in (CI) phenomenon, in graphic copying tasks. Recent evidence would suggest that apathetic symptoms are related to frontal dysfunctions in AD patients, whereas the cognitive bases of depressive symptoms in AD are still unclear. Recent studies demonstrated that frontal dysfunctions are also involved in the genesis of CI in AD patients.Objective: Since frontal dysfunctions are thought to be more strongly related to apathetic than depressive symptoms, here we tested the hypothesis that CI is significantly associated with apathy in AD patients.Methods: Forty-four AD patients were enrolled for this study. All patients completed a neuropsychological evaluation of visuo-spatial, frontal/executive, visuo-constructional, and memory skills. Moreover, graphic copying tasks were employed to detect CI, and behavioral scales to assess apathetic and depressive symptoms.Results: CI and apathetic and depressed symptoms occurred in more than half of the present AD sample, but regression models revealed that the number of CI was significantly related to apathy only. The number of CI was also significantly correlated with severity of apathetic but not of depressive symptoms.Conclusion: The present study demonstrated that CI and apathy are correlated with each other in mild to moderate AD, likely because they share common pathogenic mechanisms related to frontal/executive dysfunctions. © 2015-IOS Press and the authors. Source

Di Minno M.N.D.,University of Naples Federico II | Peluso R.,University of Naples Federico II | Iervolino S.,Scientific Institute of Telese Terme BN | Lupoli R.,University of Naples Federico II | And 3 more authors.
Arthritis Care and Research

Objective We prospectively evaluated whether obesity impacts achievement of minimal disease activity (MDA) in subjects with psoriatic arthritis (PsA). Methods Among PsA subjects with an active disease and who were starting a treatment with tumor necrosis factor α blockers, 135 obese (body mass index [BMI] >30 kg/m2) patients and 135 patients of normal weight (controls) were followed up for 24 months. At baseline and at the 12- and 24-month followup, all subjects underwent a clinical, rheumatologic, and laboratory assessment. Results With the exception of the prevalence of hypercholesterolemia and hypertriglyceridemia, case and control subjects were similar for all the clinical and demographic characteristics analyzed. At the 12-month followup, in both cases and controls, no significant changes in body weight were found (P > 0.05 for all). MDA was achieved by 98 (36.3%) of the 270 PsA individuals. The prevalence of obesity was higher in those that did not achieve MDA than in those that did (64.0% versus 25.5%; P < 0.001). After adjusting for all the other variables, obesity was associated with a higher risk of not achieving MDA (hazard ratio [HR] 4.90, 95% confidence interval [95% CI] 3.04-7.87; P < 0.001). The HR of not achieving MDA was 3.98 (95% CI 1.96-8.06, P < 0.001) and 5.40 (95% CI 3.09-9.43, P < 0.001) in subjects with first-degree (BMI <30 kg/m2) and second-degree (BMI 30-35 kg/m2) obesity, respectively. Among the 98 subjects who had achieved MDA at the 12-month followup, the presence of obesity was associated with a poor probability of sustained MDA at the 24-month followup (HR 2.04, 95% CI 1.015-3.61; P = 0.014). Conclusion Obesity is a negative predictor of achieving and maintaining MDA. Copyright © 2013 by the American College of Rheumatology. Source

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