PubMed Health⌕ Search

Biomedical subjects

Giovanni B Frisoni

Publications and source records attributed to Giovanni B Frisoni.

At least 55 records · Page 3Linked to original sources
PubMed2002

Development of a CT-based weighted rating scale for subcortical cerebrovascular disease sensitive to mild clinical symptoms.

OBJECTIVE: To devise and validate a CT-based visual rating scale sensitive to subcortical cerebrovascular disease (sCVD) in patients with cognitive impairment. METHODS: Three types of vascular lesions were rated separately in 16 brain regions. A unique vascular score was computed weighing the regression coefficients of the three scores in linear models. Thereafter, subcortical vascular classes (SVC) of increasing severity (0-3) were created. Known-group and convergent validity of the SVC was tested in 122 cognitively impaired patients with MMSE of 18 and higher. These patients were grouped according to clinical diagnosis in degenerative, mixed, and vascular. RESULTS: Intraclass correlation coefficients were between 0.86 and 0.94. The subcortical vascular score was 8.0+/-9.4 in the degenerative, 33.0+/-17.2 in the mixed, and 36.8+/-14.8 in the vascular patients (p=0.0001). In particular, none of the degenerative patients had SVC=3, and only 14% had SVC=2. On the contrary, none of the mixed and vascular patients had SVC=0, while about 50% had SVC=3 in both groups. The prevalence of hypertension was increasing with increasing SVC (p for trend=0.02). The performance on tasks evaluating balance, gait, and bradykinesia decreased with increasing SVC severity (p for trend=0.006, 0.01, 0.001, respectively). CONCLUSION: The scale is a valid tool to estimate the vascular component in patients with cognitive impairment.

Aged↗
PubMed2002

Clinical characteristics of frontotemporal patients with symmetric brain atrophy.

In this paper we explored patterns of frontal and temporal asymmetry in frontotemporal dementia (FTD) and tried to isolate clinical correlates associated with asymmetry or lack thereof. Volumes of frontal and temporal lobes, hippocampus and entorhinal cortex were measured using magnetic resonance imaging (MRI) in 10 patients with FTD. Age- and cranial size-specific values were computed through linear regression analysis (W-scores). A subgroup of 3 patients with symmetric frontal and temporal atrophy was identified. When compared to patients with asymmetric atrophy, the former had younger age at onset of the disease (p = 0.02), greater overall frontotemporal (p = 0.02) and greater entorhinal atrophy (p < 0.04). Two of the three patients were apolipoprotein E epsilon4 carriers versus none of the asymmetric patients (p = 0.02). The lack of asymmetry in this small sample of FTD patients was associated with greater brain atrophy, younger age at onset, and presence of the epsilon4 allele of apolipoprotein E. The presence of the epsilon4 allele is consistent with the hypothesis of greater vulnerability of the brain in epsilon4 carriers.

Aged↗
PubMed2002

Mild cognitive impairment with subcortical vascular features: clinical characteristics and outcome.

OBJECTIVES: To identify non-demented individuals with cognitive impairment due to a cerebrovascular etiology among those coming to observation of a memory clinic and to describe their clinical features and outcome. METHODS: Patients were enrolled in a prospective study on early cognitive impairment carried out in a Memory Clinic. Mild cognitive impairment of the vascular type (MCI-V) was defined based on modified criteria for subcortical vascular dementia (SVD) by Erkinjuntti and colleagues. Twenty-nine patients with MCI-V (age 78 +/- 7, Mini Mental State Exam (MMSE) 24 +/- 3) were compared with 14 with mild cognitive impairment of degenerative etiology (MCI) based on the Mayo Clinic criteria (age 72 +/- 9, MMSE 25 +/- 2), and to 21 patients with frank SVD (age 80 +/- 6, MMSE 21 +/- 3). Patients were followed over time for 32 +/- 8 months. RESULTS: MCI-V patients had a neuropsychological profile characterized by poor performance on frontal tests (Wisconsin card sorting and word fluency) and neurological features of parkinsonism without tremor (impairment of balance and gait). Of those followed for at least 40 months, 50 % of patients with MCI-V and SVD had died, while all MCI patients were still alive ( P = 0.03). Of those alive, 68 % of the MCI-V, 52 % of the SVD, and 17 % of the MCI patients had reached one of the following outcomes at 40 months: nursing home placement, functional loss, and cognitive deterioration ( P = 0.02). CONCLUSIONS: Patients with MCI-V have a distinctive clinical picture and can be identified in a clinical setting. Because of the high frequency of adverse outcomes, very early preventive measures need to be devised.

Aged↗
PubMed2002

Regional brain atrophy in patients with mild Alzheimer's disease and delusions.

BACKGROUND AND OBJECTIVE: The pathophysiology and the neurobiology of the behavioral disturbances in Alzheimer's disease (AD) are far from understood. The aim of the study was to assess whether delusional AD patients have a specific pattern of regional brain atrophy. METHODS: The setting of the study was the outpatient facility of a memory clinic. Subjects were 41 AD patients with mild dementia severity (Mini-Mental State Exam score of 22 +/- 3, range 18 to 27). Delusions were assessed with the pertinent subscale of the UCLA Neuropsychiatric Inventory (NPI). Nondelusional (n = 22) AD and delusional (n = 19) AD were defined on the basis of absence (NPI delusions subscale = 0) or presence (NPI delusions subscale = 1 or higher) of delusions. Thirteen (68%) of the delusional patients had isolated theft delusions, and 6 (32%) had theft associated with another paranoid delusion (of jealousy or persecution). None of the patients had misidentifications or other delusions of nonparanoid content. Temporal lobe and frontal lobe atrophy were assessed with linear measures (radial width of the temporal horn, rWTH, and frontal index, FI) taken from computed tomographic films. Temporal and frontal asymmetries were computed as right/left ratio of the rWTH and FI. RESULTS: AD patients without delusions had symmetrical enlargement of both temporal (8.1 +/- 3.9 vs. 8.5 +/- 4.5) and frontal horns (35.8 +/- 4.8 vs. 35.9 +/- 4.6). On the contrary, AD with delusions showed temporal horns larger to the right (9.1 +/- 3.3 vs. 7.7 +/- 3.1, p = .06) and the frontal horn to the left (35.7 +/- 4.3 vs. 37.5 +/- 4.2, p = .02). This different pattern was confirmed with a gender-adjusted repeated measures analysis of variance model interaction term between asymmetry and group: F1,38 = 5.5, p = .03). DISCUSSION: AD patients with delusions are characterized by a specific pattern of frontal and temporal asymmetry of brain atrophy, whereas nondelusional patients are symmetric. Because the asymmetry pattern of the delusional patients is similar to the physiological pattern of asymmetry of individuals without dementia, the data indicate that the absence of theft delusions in the mild stage of AD rather than their presence is associated with an abnormal asymmetry pattern.

Aged↗
PubMed2002

Caregiver's distress is associated with delusions in Alzheimer's patients.

Behavioral disturbances in Alzheimer's (AD) patients might be caused by environmental factors. The authors tested the hypothesis that delusions in AD might be a result of caregiver's distress. Participants were 22 delusional and 21 nondelusional mild AD patients and their caregivers. Those who cared for nondelusional patients, compared with the delusional patients' caregivers, reported higher levels of distress because of behavioral disturbances other than delusions. When patients were stratified into 2 groups according to median distress value, 64% of the delusional patients and 33% of the nondelusional patients showed a high level of caregiver's distress, chi2(1, N = 43) = 3.94, p = .047. Although final conclusions about the causal direction of the association cannot be drawn, these findings are consistent with the hypothesis that distressed caregivers might use inappropriate coping strategies that, in turn, might favor the development of delusions.

Aged↗
PubMed2002

Predictors of cognitive improvement after reality orientation in Alzheimer's disease.

BACKGROUND: there is increasing evidence to support the efficacy of reality orientation in cognitive deficits in patients with Alzheimer's disease. The clinical characteristics of patients who respond to reality orientation are poorly understood; this knowledge could be important, given that the provision of reality orientation therapy is labour-intensive and may provoke emotional distress. AIM: to evaluate retrospectively which demographic and clinical characteristics of Alzheimer's patients predict cognitive outcomes. METHOD: we analysed 38 mild-to-moderately demented outpatients who regularly attended a one-month formal reality orientation programme. The mini mental state examination score changes from baseline-and immediately after-reality orientation were correlated with demographic and pre-treatment clinical characteristics by a linear regression analysis. RESULTS: short-term responsiveness to reality orientation was significantly predicted by a lower level of cognitive functioning (as measured by the mini mental state examination) at baseline and by the absence of euphoria, accounting together for 57.6% of variance. CONCLUSION: a lower mini mental state examination and the absence of euphoric behaviour in patients with mild-to-moderate Alzheimer's disease may predict a good cognitive outcome of reality orientation therapy.

Aged↗
PubMed2002

Geriatric Index of Comorbidity: validation and comparison with other measures of comorbidity.

BACKGROUND: the debate about measures of chronic comorbidity in the elderly is mainly due to the lack of consensus on pathogenetic models. OBJECTIVE: the aim of the present study was to compare the concurrent validity of a number of measures of chronic comorbidity assuming different pathogenic models, versus disability in elderly patients. SETTING: the Geriatric Evaluation and Rehabilitation Unit for subacute and disabled patients. PARTICIPANTS: 493 new and consecutive elderly patients (mean age 79 years, 71% females) admitted to the Geriatric Evaluation and Rehabilitation Unit. MEASUREMENTS: we evaluated age, gender, cognitive status, depressive symptoms, functional status, somatic health, and nutritional status on admission. Functional status was assessed by the self- or proxy reported Katz's BADL scale and by the performance-based Reuben's Physical Performance Test. Somatic health was assessed as presence and severity of diseases according to standardized criteria. Comorbidity was measured as number of diseases, sum of disease severity, and with a composite score (Geriatric Index of Comorbidity) which takes into account both number of diseases and occurrence of very severe diseases. Mortality was assessed after 12 months. RESULTS: specific diseases and their severity were found to be associated with disability measures. All measures of comorbidity were significantly correlated with disability, but only the Geriatric Index of Comorbidity was independently associated after adjustment for severity of individual diseases. In addition, increasing severity of comorbidity as defined by Geriatric Index of Comorbidity was associated with greater disability while this was not true for the other comorbidity measures (F statistics for the regression model including the Geriatric Index of Comorbidity=19.9). The Geriatric Index of Comorbidity, but not the other comorbidity measures, predicted mortality (relative risk of death 2.3, 95% confidence interval 1.7-3.1). CONCLUSION: the Geriatric Index of Comorbidity, a measure of comorbidity assuming that both number of diseases and occurrence of very severe diseases are determinants of health, has the greatest concurrent validity with disability and is the best predictor of mortality.

Aged↗
PubMed2002

The radial width of the temporal horn in mild cognitive impairment.

BACKGROUND AND PURPOSE: The diagnosis of preclinical Alzheimer's disease (AD) (or mild cognitive impairment [MCI]) is loaded with a high degree of uncertainty. The aim was to test the accuracy of a computed tomography-based (CT-based) marker of medial temporal lobe atrophy, the radial width of the temporal horn (rWTH), in MCI. METHODS: Ten MCI and 42 AD patients and 29 nondemented controls underwent brain CT on the temporal lobe plane (slice thickness = 2 mm). The rWTH was taken on CT films with a precision caliper placed at the tip of the temporal horn radial to the curvature of the hippocampal head region. RESULTS: When specificity was fixed at 95%, the sensitivity for the detection of AD was 39/42 (93%) and that for the detection of MCI was 8/10 (80%). CONCLUSION: The rWTH is a measure sensitive to the regional brain atrophy common in early AD.

Aged↗
PubMed2002

Hashimoto's encephalopathy in the elderly: relationship to cognitive impairment.

Hashimoto's encephalopathy (HE) is a steroid-responsive encephalopathy associated with high titers of antithyroid antibodies. To date, 57 pediatric-, adult-, and elderly-onset cases have been described in the literature. The clinical picture is pleomorphic, and cognitive impairment is a frequently reported symptom. We report the case of a patient with slowly progressive cognitive impairment possibly caused by HE. The issue of the differential diagnosis with primary dementia is discussed. A review of cases of HE showing cognitive deterioration is also presented, and factors possibly related to characteristics of cognitive impairment and outcome after therapy are considered.

Antibodies↗
PubMed2002

Radial width of the temporal horn: a sensitive measure in Alzheimer disease.

BACKGROUND AND PURPOSE: Atrophy in the medial temporal lobe (MTL) structures depicted with brain imaging is one of the most accurate markers of Alzheimer disease (AD), but practical considerations have thus far limited their routine clinical use. The aim of this study was to explore the validity of a CT- and MR-based measure of MTL atrophy that would be feasible for routine clinical use. METHODS: We acquired brain CT scans in the temporal lobe plane with thin sections in 42 patients with AD and in 29 control patients without dementia. We also acquired MR images (according to a 3D magnetization-prepared rapid gradient-echo protocol) in 28 patients with AD and in 28 control subjects without dementia. The radial width of the temporal horn (rWTH) of the lateral ventricle was measured with a precision caliper at the tip of the horn on CT scans or high-quality MR images. The validity of the rWTH variable was assessed by test-retest and interrater reliability, convergent and discriminant validity compared with progressively distant brain regions, and known-group validity (accuracy of the separation of patients with AD from control subjects). Convergent and discriminant validity compared with volumetric measures was tested in the patients who underwent MR imaging. RESULTS: Intraclass correlation coefficients for inter- and intrarater reliability were between 0.94 and 0.98. On CT scans, Pearson's correlation of the rWTH with the transverse width of the temporal horn was between 0.60 and 0.79; with Jobst's minimum thickness of the MTL, between 0.63 and 0.78 (interuncal distance approximately 0.50); and with an index of frontal atrophy, between 0.35 and 0.42. On MR images, the correlation with volumetric MR measures was 0.80 in the temporal horn, 0.74 in the hippocampus, 0.68 in the temporal lobe, 0.58 in the entorhinal cortex, and 0.49 in the frontal lobe. On CT scans (cutoff value for AD, >5.3 mm; age range of subjects, 50-90 y), the rWTH measure was a sensitive marker for AD in 39 of 42 patients with AD (sensitivity, 93%) and was a specific marker in 28 of the 29 control patients (specificity, 97%). On MR images (cutoff 3.6-6.7 mm; age range of subject, 50-90 y), the rWTH was a sensitive marker for AD in 21 of 28 patients with AD (sensitivity, 75%) and was a specific marker in 26 of 28 control subjects (specificity, 93%). The accuracy of other linear CT-based measures of MTL atrophy and linear and volumetric MR-based measures was lower. With specificity set to 95%, sensitivity ranged from 57% to 74% for CT-based measures and from 52% to 74% for MR-based measures. CONCLUSION: The rWTH is an accurate marker of AD that could be used in routine clinical settings.

Aged↗
PubMedDate not supplied

The MRI pattern of frontal and temporal brain atrophy in fronto-temporal dementia.

OBJECTIVE: To compare patterns of brain atrophy in fronto-temporal dementia (FTD) and Alzheimer's disease (AD) since atrophy in individual areas may not be sufficiently specific as diagnostic marker. METHODS: Frontal, temporal and hippocampal atrophy was measured from MRI of 10 FTD patients, 27 AD, and 27 controls. Corrected atrophy and asymmetry were computed (W-scores). RESULTS: FTD had mild atrophy in the hippocampus (average W-score=-1.3), severe in the frontal (W-score=-2.4) and very severe in the temporal lobes (W-score=-2.9). AD had moderate atrophy in the hippocampus and temporal lobes (W-score=-1.8 and -1.9, respectively), and very mild frontal atrophy (W-score=-0.9). Atrophy was more asymmetrical in FTD (left more atrophic) than in AD patients, particularly in the temporal lobes. A discriminant function including the asymmetry values of frontal and temporal regions could separate FTD from AD with 90% sensitivity and 93% specificity. CONCLUSIONS: FTD is characterized by a specific pattern of atrophy, more useful than atrophy of single regions in the differential diagnosis.

Aged↗
PubMedDate not supplied

Validation study of the three-objects-three-places test: a screening test for Alzheimer's disease.

The aim of the present study was to validate a short, ecological test of episodic memory for the screening of Alzheimer's disease (AD). The validation was performed by computing intrarater reliability, homogeneity, internal coherence, convergent, discriminant and known group validities in the performance of normal subjects (N = 65), mild cognitive impairment (MCI) patients (N = 114), and AD (N = 44) and non-AD demented (N = 39) patients. Intrarater reliability was 0.88, homogeneity ranged from 0.81 to 0.97, and internal coherence was 0.87. With respect to convergent and discriminant validities, the test loaded strongly on memory factor (value = 0.64) and weakly on other nonmemory factors. The known group validity showed a specificity between 87% and 91% and a sensitivity between 92% and 100% in correctly identifying AD in age classes ranging from 50 to 65 and 66 to 80 years. The test is a valid instrument for the screening of AD.

Aged↗