Biomedical subjects

A R Giovagnoli

Publications and source records attributed to A R Giovagnoli.

At least 19 recordsLinked to original sources

PubMed2006

Methotrexate based chemotherapy and deferred radiotherapy for primary central nervous system lymphoma (PCNSL): single institution experience.

In the following study, we present our experience in the treatment of PCNSL patients using a multi-step schedule combining chemotherapy and deferred radiotherapy. Patients were treated with two modified M-BACOD cycles and then differently according to radiological response For PR, SD and PD patients, chemotherapy was interrupted and radiotherapy initiated immediately (45 Gy Whole-brain RT). With CR patients, chemotherapy was continued with a combination of HMTX, VCZ, PCB and HD Ara-C up to a total of nine cycles. In 36 patients suitable for evaluation (2 patients had undergone tumour resection): 69.4% (25 of 36) had a complete response (CR), 19.4% (7 of 36) had a partial response(PR), 8.3% (3 of 36) had stable disease(SD), and 2.7% (one of 36) had progressive disease (PD). The PR, SD and PD patients were immediately treated by radiotherapy. In this cohort of patients, we observed 6 CR, 4 PR and 2 PD, respectively, following radiotherapy. At first relapse, a total of 16 CR patients were treated by radiotherapy for a total dose of 45 Gy. The OS was 42.1 months for the entire group of patients. In CR patients treated at the moment of recurrence by salvage radiotherapy, the TTP (time lasting from histological diagnosis until recurrence of disease before RT) was 28.3 months, with a 43.4% of disease free patients observed at 2 years. The median disease-free time observed after complete response to radiotherapy was 10.5 months. In 16 patients (34%), further progression of disease was observed following radiotherapy. Two patients developed extra-CNS disease in the breast and testis. When taking into account the patients with radiotherapy delayed at recurrence, the OS was 48 months and the survival rates were 70% and 60% at 2 years and 5 years, respectively.

Adolescent↗

PubMed2005

Facets and determinants of quality of life in patients with recurrent high grade glioma.

OBJECTIVES: To assess patients with recurrent high grade brain glioma with the aim of evaluating facets of quality of life (QOL) and their association with mood, cognition, and physical performance. METHODS: Ninety four glioma patients (four groups with different duration of glioma recurrence) were compared with 24 patients with other chronic neurological diseases and 48 healthy subjects. The Functional Living Index-Cancer (FLIC) provided QOL self evaluations, and standardised scales and neuropsychological tests assessed physical performance, mood, and cognition. RESULTS: In glioma patients, factor analysis of the FLIC items documented five domains: Psychological well being, Role/sociability, Inner experience of disease, Isolation/sharing, and Nausea. Higher FLIC total scores were related to better cognition, physical performances, and mood, and lower grading; poorer Psychological well being and worse Inner experience of disease to depressed mood; minor Role/sociability to worse cognitive and physical performances and higher grading; worse Nausea to longer disease duration. Compared with healthy subjects, all glioma groups were cognitively impaired and more anxious, and two groups with short duration of recurrence were also more depressed. Patients with chronic neurological diseases showed worse mood and cognitive abilities compared with healthy subjects, but performed attention tests better than glioma patients. Glioma and chronic disease patients showed similar FLIC scores and autonomy. CONCLUSIONS: These results show that QOL of recurrent high grade glioma patients is multifaceted and determined by multiple factors. Disease severity does not necessarily eliminate the possibility of expressing personal feelings and opinions which could provide criteria for clinical decision making and psychological support.

Adult↗

PubMed2004

A family with Alzheimer disease and strokes associated with A713T mutation of the APP gene.

Three members of an Italian family with autosomal dominant dementia and multiple strokes had the A713T mutation of the APP gene. The neuropathologic examination of the proband disclosed Alzheimer disease (AD) with severe cerebral amyloid angiopathy and multiple infarcts. This indicates that the A713T mutation of the APP gene, lying at the gamma-secretase cleavage site, can be responsible for AD with symptomatic cerebral amyloid angiopathy.

Alzheimer Disease↗

PubMed2001

Positive response to immunomodulatory therapy in an adult patient with Rasmussen's encephalitis.

Rasmussen's encephalitis (RE) is a rare and progressive neurologic condition of uncertain etiology that typically has a childhood onset. The authors describe a 45-year-old woman with adult-onset progressive aphasia, right hemiparesis, severe drug refractory epilepsy, and left cerebral hemisphere atrophy. High-dose corticosteroids and plasmapheresis were not effective. She improved with high-dose therapy with human IV immunoglobulin.

Brain↗

PubMed2001

Relation of sorting impairment to hippocampal damage in temporal lobe epilepsy.

One hundred and twelve patients with left (n=65) or right (n=47) temporal lobe epilepsy (TLE), associated with mesial or lateral temporal lobe lesion, were compared to 53 patients with left (n=30) or right (n=23) frontal lobe epilepsy (FLE), in order to explore the contributions of hippocampal lesions and of memory deficits to sorting impairment. Thirty-six healthy subjects of similar age and education were controls. The Modified Wisconsin Card Sorting Test (MWCST) was used to explore sorting ability. The two-syllable word span and consistent long-term retrieval from the selective reminding procedure for word-list learning were used to evaluate memory. Raven's Coloured Progressive Matrices and Attentive Matrices served to control for abstract reasoning and attention. Left FLE patients and TLE patients with left hippocampal sclerosis were significantly impaired on MWCST, short-term memory, and word learning. TLE patients with other left hippocampal lesions were also impaired on MWCST, although not significantly so. Analysis of individual scores showed that 42% of TLE patients with left hippocampal sclerosis, 14% of TLE patients with other hippocampal lesions, 63% of left FLE patients, and 30% of right FLE patients were impaired on the MWCST. In patients with left hippocampal sclerosis, MWCST score was associated with the learning score provided by the selective reminding procedure and Raven's Coloured Progressive Matrices score, whereas in FLE patients, MWCST score was associated with Attentive Matrices score. These results suggest that only some TLE patients, i.e. those with hippocampal damage, may be expected to be impaired on card sorting. The impaired sorting ability of these TLE patients may be due to involvement of the hippocampal function in forming associations or in registering new information.

Adult↗

PubMed2001

Preserved semantic access in global amnesia and hippocampal damage.

C.B., a right-handed 33-year-old man, presented with anterograde amnesia after acute heart block. Cognitive abilities were normal except for serious impairment of long-term episodic memory. The access to semantic information was fully preserved. Magnetic resonance showed high signal intensity and marked volume loss in the hippocampus bilaterally; the left and right parahippocampal gyrus, lateral occipito-temporal gyrus, inferior temporal gyrus, and lateral temporal cortex were normal. This case underlines that global amnesia associated with hippocampal damage does not affect semantic memory. Although the hippocampus is important in retrieving context-linked information, its role is not so crucial in retrieving semantic contents. Cortical areas surrounding the hippocampus and lateral temporal areas might guide the recall of semantic information.

Adult↗

PubMed2000

Quality of life and memory performance in patients with temporal lobe epilepsy.

OBJECTIVE: To explore the contribution of memory performance to quality of life (QOL) in patients with left or right temporal lobe epilepsy (TLE). SUBJECTS AND METHODS: Sixty-five patients with left or right TLE compiled the QOL in Epilepsy-89 Inventory (QOLIE-89), the State-Trait Anxiety Inventory (STAI) and the Hopelessness Scale (BDI) for self-evaluation of QOL and mood. Memory was assessed by tests of verbal and non-verbal memory and the Questionnaire of Memory Efficiency (QME). A neuropsychological battery was also administered to assess general intelligence, attention, visual perception, language, set shifting, word fluency and conceptual-motor tracking. RESULTS: On factor analysis, the neuropsychological battery and mood scales consisted of six factors (Memory, Mental Speed, Mood, Praxis, Sorting and Perception), while the QOLIE-89 consisted of five factors (Psychosocial Satisfaction, Epilepsy-Related Effects, Role, Physical Performance, Cognition). On regression analysis, overall QOLIE-89 score was predicted by the factor Mood and QME score. The QOLIE-89 factor Cognition was predicted by QME score and the Memory, Mental Speed, Perception and Praxis factors of the neuropsychological battery. CONCLUSION: In TLE patients self-reported memory, as assessed by QME, is an important predictor of QOL, and also correlates with performance on memory tests. This suggests that memory improvement by specific training may help to improve QOL in these patients.

Adolescent↗

PubMed1999

Learning and memory impairment in patients with temporal lobe epilepsy: relation to the presence, type, and location of brain lesion.

PURPOSE: To study the influence of epileptogenic lesions on learning and memory alterations in patients with temporal lobe epilepsy (TLE). METHODS: We studied 131 patients (55 with left and 39 with right lesional TLE; 22 with left and 15 with right cryptogenic TLE) and 36 healthy subjects. We compared these groups by using a battery of tests to assess verbal and visual learning, delayed recall, and recall after the imposition of interfering activity. RESULTS: Compared with the controls and patients with right TLE, the patients with left TLE were significantly impaired on all verbal tests. On visual tests, patients with right TLE were impaired compared with controls but not more so than patients with left TLE. Separate multivariate analyses of variance (MA-NOVAs) of patients' verbal and visual test scores, taking the TLE side and morphologic features of the temporal lobes (i.e., normal, hippocampal sclerosis, low-grade glioma, or cavernous angioma) as independent factors, did not show any significant effect of these features. Separate comparisons of verbal and visual test scores of patients with lesional TLE, taking the side and location (mesial or lateral) of the epileptogenic lesion as independent factors, did not show any significant effect of location. CONCLUSIONS: Our findings show that some learning and memory abilities are impaired in patients with TLE irrespective of the presence of overt damage. This supports the theory that focal epileptic discharges, rather than the lesions themselves, affect these functions. The pathologic characteristics and intratemporal location of an associated lesion do not seem to play an important role in determining learning and memory impairment when clinical and treatment-related factors are taken into account.

Brain Diseases↗

PubMed1999

Verbal semantic memory in temporal lobe epilepsy.

OBJECTIVES: Temporal lobe epilepsy (TLE) may determine memory difficulties not explained by episodic memory impairment. The present study was aimed to verify the presence of specific semantic memory dysfunctions in TLE and to explore their relations to epilepsy variables. SUBJECTS AND METHODS: Forty-seven patients with lateralized temporal (n = 26) or extra-temporal lobe epilepsy (n = 21) and 23 healthy subjects were compared. Picture Naming and Pointing to a Picture were used to explore expressive and receptive vocabulary and the Semantic Questionnaire evaluated semantic judgment of verbally presented items. The Selective Reminding Procedure for word list learning and Story Recall were used to assess episodic memory. Spontaneous speech and the Token Test controlled for language disturbances, and Raven's Coloured Progressive Matrices were used to evaluate abstract reasoning ability. RESULTS: Multivariate analysis of variance of test scores showed significant impairment of semantic memory in patients with left TLE compared to healthy controls, whereas episodic memory was impaired in left temporal and extra-temporal epilepsy (as measured by word learning) and all epilepsy groups (as measured by Story Recall). In the TLE groups, naming abilities were more compromised than single-word comprehension and semantic judgment - which were not significantly affected. No deficits in language abilities or in abstract reasoning were found in any patient group. Factor analysis of memory tests scores in the patients produced two factors, one semantic and the other episodic. Regression analysis revealed that the semantic factor was related to abstract reasoning, left hemisphere lateralization of seizures, and age of seizure onset; while the episodic factor was related to age. CONCLUSIONS: Left TLE may determine significant verbal semantic memory compromise, maybe due to impaired access to the semantic-lexical storage. In non-aphasic epilepsy patients, comparison of performance on semantic and episodic memory tests may be useful for assessing the nature of memory failures, and may complement clinical and neurophysiological means for defining the epileptic center.

Adolescent↗

PubMed1999

Quality of life in patients with stable disease after surgery, radiotherapy, and chemotherapy for malignant brain tumour.

OBJECTIVES: to evaluate quality of life in patients with malignant brain tumour with stable disease after combined treatments in comparison to patients with other chronic neurological conditions, and to explore the relation of quality of life to clinical, pathological, affective and cognitive factors. METHODS: fifty seven patients who were stable after surgery, radiotherapy and chemotherapy and 24 controls with spastic paraparesis, peripheral neuropathies, myasthenia, ataxia, Parkinson's disease, or multiple sclerosis, were studied. Patients were evaluated by functional living index-cancer, Karnofsky performance status, activity of daily living, self-rating depression scale, state-trait anxiety inventory, and tests for cognitive abilities. RESULTS: separate Mann-Whitney test comparisons did not show any difference in measures of health related quality of life (functional living index-cancer), autonomy in daily life (activity of daily living), or mood between tumour and control patients, although the first had slower mental speed and worse attention. Seventy three per cent of patients with brain tumour and 58% of the control patients continued or resumed previous work activity. Quality of life was significantly associated with depression, state anxiety, and performance status in the patients with brain tumour, whereas in control patients, state anxiety was the only factor related to quality of life. CONCLUSIONS: after intensive multimodality treatments, selected patients with brain tumour with stable disease may have satisfactory quality of life that may be not worse than in patients with other chronic neurological illnesses. During the period of stable disease, depressed mood, possibly a reaction to impaired physical and cognitive performance, seems to play a major role in determining quality of life.

Adult↗

PubMed1997

Self-reporting of everyday memory in patients with epilepsy: relation to neuropsychological, clinical, pathological and treatment factors.

Patients with epilepsy frequently complain of memory problems, but neuropsychological tests sometimes fail to detect consistent deficits; this may be because laboratory tests are poor indicators of everyday memory problems, or because subjective memory difficulties may be provoked by a variety of factors. To address these issues, we compared 100 patients with epilepsy and 57 healthy controls by means of our Questionnaire of Memory Efficiency, the State-Trait Anxiety Inventory, the Self-Rating Depression Scale and a battery of tests. The Chronbach test showed the Questionnaire of Memory Efficiency to be satisfactorily reliable. Patients reported significantly greater memory difficulties and higher levels of anxiety and depression than controls. Questionnaire of Memory Efficiency scores correlated with anxiety and depression levels, as well as with memory and learning test scores and regression analysis showed that anxiety, depression and visual learning had the most consistent explanatory power. No correlation was found with clinical variables or the presence of detectable brain lesion. Patients undergoing polytherapy or treatment for long periods reported the greatest memory difficulties. These findings suggest that subjective perception of memory failure reflects objective memory impairment. However, emotional factors and low self-esteem may bloat the reporting of everyday memory difficulties. The Questionnaire of Memory Efficiency seems able to provide information about everyday memory problems in patients with epilepsy that may be useful for planning neuropsychological counselling or rehabilitation.

Adult↗

PubMed1996

Quality of life in brain tumor patients.

With the aim of evaluating the quality of life (QL) of 101 brain tumor patients, a multidimensional approach was adopted, using the Functional Living Index-Cancer (FLIC) as a global measure of well-being, the Karnofsky Performance Scale (KPS) and the Index of Independence in Activity of Daily Living (ADL) as indices of physical and functional dimensions, the State-Trait Anxiety Inventory (STAI) and the Self-Rating Depression Scale (SRDS) for psychological assessment, and neuropsychological tests for abstract reasoning, attention, memory and frontal lobe functions. The patients were grouped on the grounds of disease stage and treatment. The FLIC and KPS ratings increased from the patients who had just undergone surgery to patients who were disease-free after completing chemotherapy and radiotherapy, thus showing that the QL may improve during the disease despite aggressive treatments, providing there is no tumor recurrence. However, only the FLIC consistently discriminated the patients' stratification. The ADL revealed no between-group differences, whereas the STAI and SRDS revealed the presence of emotional troubles at the beginning and at the end of treatment. Cognitive impairment was more serious after radiotherapy and chemotherapy, as well as in patients with tumor recurrence. The FLIC significantly correlated with all of the other scales used, showing that it is useful in summarizing both the physical and psychosocial impairment of brain tumor patients. Of the pathological variables, a tumor location in the anterior right hemisphere or diencephalon was associated with high FLIC ratings, may be due to the minor cognitive impairment observed in patients with these tumor sites. Of the demographic variables, the level of education was associated with high FLIC ratings, thus highlighting the role of psychosocial environment in improving the QL. The use of a multidimensional approach or a global index of well-being that also reflects psychosocial and cognitive aspects proved to be more appropriate than traditional functional instruments (such as the KPS) in assessing the QL of brain tumor patients and in detecting the extent of the disease.

Adult↗

PubMed1996

Trail making test: normative values from 287 normal adult controls.

The Trail Making Test (TMT), which explores visual-conceptual and visual-motor tracking, is a frequently used neuropsychological test because of its ease of administration and sensitivity to brain damage. In this paper, norms are provided for the time scores derived from parts A and B, and for the (B-A) difference. The data were collected from 287 adult Italian subjects stratified by gender, schooling and age (from 20 to 79 years). The test scores were affected by age, education and general intelligence (as expressed by Raven's Coloured Progressive Matrices). Only for part A did females have longer time scores than males. Test-retest reliability was high for each score.

Adolescent↗

PubMed1996

Forgetting rate and interference effects on a verbal memory distractor task in patients with temporal lobe epilepsy.

To investigate interference effects in lateralized temporal lobe epilepsy (TLE), we compared 79 patients with left (n = 43) or right (n = 36) TLE and 33 healthy controls on a verbal memory distractor task (VMDT) structured according to the Brown-Peterson paradigm. The subjects were also administered a selective reminding procedure (SRP) for verbal learning, a word fluency test (WFT) and the Wisconsin Card Sorting test (WCST) for "frontal" functions. On the VMDT, left TLE patients were significantly impaired as compared to right TLE patients and controls. This impaired performance correlated with the severity of learning and short-term memory deficit but not with deficits on the WFT or the WCST. Our data suggest that lateralized epileptic discharges may affect the function played by the medial temporal lobe in inhibiting interference, thus contributing to the material-specific memory deficit of TLE patients.

Adult↗

PubMed1995

Visual learning on a selective reminding procedure and delayed recall in patients with temporal lobe epilepsy.

We administered a visual selective reminding procedure for the learning of designs to healthy controls and to left or right temporal lobe epilepsy (TLE) patients without demonstrable brain lesions. In comparison with the other groups, right TLE patients showed a deficit of learning characterized by an impairment in storing visual material and consistently retrieving it from long-term memory. Patients with left TLE performed similarly to controls. These data are consistent with the hypothesis of right hippocampal involvement in the learning of nonverbal material. Delayed retrieval of learned material was similar in all the subject groups tested at long time intervals, suggesting the impairment of learning in patients with right TLE does not necessarily imply a subsequent deficit in the retrieval of stored information. This finding may agree with the opinion that distinct functional systems subserve learning and memory.

Adult↗

PubMed1994

Cognitive impairment and quality of life in long-term survivors of malignant brain tumors.

Thirtysix long-term survivors following the treatment of a malignant supratentorial brain tumor were examined for cognitive functions and global level of autonomy. Eighteen patients were symptom-free (SF) and 18 had clinical and neuroradiological recurrence (RE). The control group included 30 healthy subjects. All subjects underwent a neuropsychological battery for general and specific cognitive functions. The level of autonomy was assessed by means of the Karnofsky Performance Scale (KPS) for oncological patients. SF patients showed less impairment than RE patients both at the tests, as well as on the KPS. The cognitive deficits were subclinical in most SF patients, the tests for attention, memory and word fluency being the most sensitive in detecting subtle dysfunctions. The association between tumor location and specific cognitive deficits was inconstant in both patient groups. The results suggest that even subtle cognitive deficits can prevent SF long-term survivors from returning to premorbid autonomy and occupations, and that neuropsychological tests may be used as complementary routine indicators of their quality of life. Furthermore, our data show that, in selected patients, combined treatments and therapeutic insistence do not necessarily have the same deleterious effects.

Adolescent↗

PubMed1993

Crossed aphasia. Report of a rare case in a glioblastoma patient.

A rare case of a right-handed (on the Edinburgh Inventory) woman who developed aphasia at the clinical onset of a right hemisphere glioblastoma (GBM) is reported. She showed Wernicke aphasia and left spatial neglect. The integrity of the left hemisphere was assessed by Magnetic Resonance Imaging (MRI). A few aspects of hemispheric specialization for language, praxias and spatial abilities are briefly discussed.

Aphasia, Wernicke↗

PubMed1992

Gliomatosis cerebri. Report of a case with isolated amnesic disorders.

We describe the case of a female patient with behavioral and memory disorders. A neuropsychological evaluation confirmed the absence of mental deterioration and the presence of the psychometric features of the amnesic syndrome. The clinical diagnosis was supported by MRI and histological examination.

Adult↗