From aMCI to AD: The Role of Visuo-Spatial Memory Span and Executive Functions in Egocentric and Allocentric Spatial Impairments

A difficulty in encoding spatial information in an egocentric (i.e., body-to-object) and especially allocentric (i.e., object-to-object) manner, and impairments in executive function (EF) are typical in amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD). Since executive functions are involved in spatial encodings, it is important to understand the extent of their reciprocal or selective impairment. To this end, AD patients, aMCI and healthy elderly people had to provide egocentric (What object was closest to you?) and allocentric (What object was closest to object X?) judgments about memorized objects. Participants' frontal functions, attentional resources and visual-spatial memory were assessed with the Frontal Assessment Battery (FAB), the Trail Making Test (TMT) and the Corsi Block Tapping Test (forward/backward). Results showed that ADs performed worse than all others in all tasks but did not differ from aMCIs in allocentric judgments and Corsi forward. Regression analyses showed, although to different degrees in the three groups, a link between attentional resources, visuo-spatial memory and egocentric performance, and between frontal resources and allocentric performance. Therefore, visuo-spatial memory, especially when it involves allocentric frames and requires demanding active processing, should be carefully assessed to reveal early signs of conversion from aMCI to AD.

A-116 Neuropsychological Support for Use of Russell Posttraumatic Amnesia Classification of Traumatic Brain Injury

Objective To compare neurocognitive outcomes between 3 traumatic brain injury (TBI) groups (mild, moderate, severe) across 3 TBI classification systems: Glasgow Coma Scale (GCS) and Russell (mild <1 hour, moderate <24 hours and severe >24 hours) and the modified (mild <24 hours, moderate < one week and severe > one week) posttraumatic amnesia (PTA) systems. Method Private practice archival data were reviewed for ambulance/hospital documentation of lowest GCS and PTA duration. Exclusion criteria included ESL and failed tests of engagement. Tests included WAIS, WMS, WRAT, Halstead Reitan etc. Results There were 91 patients (16 mild, 30 moderate and 45 severe); 45 were male. Mean age and education was 30.9 and 12.6. Russell PTA classification yielded significant differences (t-tests) between mild and moderate TBI on 8 of 46 tests/measures and 13 differences in moderate versus severe and 24 differences in mild versus severe TBI. Differences were always severe > moderate > mild impairment, with most in psychomotor speed, memory, working memory and executive/frontal functions consistent with TBI. The modified PTA classification yielded 2 significant differences between mild and moderate, 6 differences between moderate and severe and 22 differences between mild and severe TBI. GCS yielded 0 differences between mild and moderate, 7 differences between moderate and severe and 14 differences between mild and severe TBI. The modified PTA and GCS reduced moderate TBI numbers and some differences were opposite expectations. Conclusions Russell PTA was superior to the modified PTA system and GCS in separation/discrimination (without reversals) and maintenance of moderate TBI as a substantive category.

Neuropsychological Pattern in a Series of Post-Acute COVID-19 Patients in a Rehabilitation Unit: Retrospective Analysis and Correlation with Functional Outcomes

Intensive Care Unit delirium, insomnia, anxiety, and frontal/dysexecutive disorders have been described following COVID-19 infection. The aim of this case study was to re-evaluate the neuropsychological pattern in a series of patients with COVID-19 outcomes. We retrospectively evaluated 294 patients admitted to the Istituti Clinici Scientifici Maugeri of Lumezzane (Brescia) (May–September 2020). Neuropsychological assessment was available for 12 patients. We extracted clinical, functional data (FIM and Barthel Index score) and neuropsychological tests (MMSE, Trail making a-b, verbal fluency test, digit span, prose memory test, Frontal Assessment Battery, clock drawing test, Rey–Osterrieth complex figure, Tower of London test). The results were analyzed by Spearman (rho) correlation. Six patients presented dysexecutive alterations even in the presence of normal overall cognitive functioning. Forward digit span score was directly correlated to FIM value at admission (p = 0.015) and inversely correlated to delta FIM (p = 0.030) and delta Barthel Index (p = 0.025). In our experience, subclinical cognitive alterations were present in 4% of patients recovering from COVID-19 pneumonia. The possible correlation between verbal memory and frontal functions, and the degree of functional impairment at admission and its subsequent improvement, underscores the importance of an adequate cognitive evaluation and rehabilitation.

Dealing With Specific Cognitive Dysfunctions Associated with Psychiatric Vulnerability in Intellectual Developmental Disorders

IntroductionDespite the increasing evidence of common neurodevelopmental alterations and high simultaneous or sequential co-occurrence, the relationship between specific cognitive dysfunctions and psychiatric vulnerability has not been adequately studied, not even in people with intellectual developmental disorders (IDD), whose rate of mental health problems is up to 4 times higher than the general population.AimThe aim of the present paper is to investigate the correlation between specific cognitive dysfunctions or dysfunctional cognitive patterns and the presence of specific psychiatric symptoms and syndromes in people with IDD.MethodsA sample of 52 individuals with IDD consecutively attending a clinical facility for multidisciplinary evaluation, in Florence, Italy was assessed through the SPAID (psychiatric instrument for intellectual disabled adult) system, the WAIS III - R (Wechsler adult intelligence scale III – Revised), the TMT (trial making test), and other neuropsychological tools. Psychiatric diagnoses were formulated by expert clinicians in accordance to DC-LD or DM-ID criteria. The main procedure of the data statistical elaboration was the calculation of frequency and correlation indexes.ResultsSome relevant correlations have been found, that between executive frontal functions, autistic traits and impulse control disorder, and that between working memory and bipolar disorder were among the strongest.ConclusionsIn people with IDD some cognitive alterations or ‘characteristics’ significantly correlate with the presence of psychiatric disorders. The possibility to understand the nature of this relationship seems to increase with the degree of specificity of variables in both the cognitive and the psychopathological assessment.

Relationships between Environmental Dependency and Closing-in in Patients with Fronto-temporal Dementia

Environmental dependency (ED) phenomena, including utilization behavior and imitation behavior, are clinical manifestations typically observed in patients with the behavioral variant of fronto-temporal dementia (bvFTD), who may also show the closing-in (CI) phenomenon. Here, we explored the neuropsychological correlates of ED and CI in bvFTD, and the association of ED with CI to clarify the mechanisms underlying these clinical manifestations. Thirty-one bvFTD patients underwent a wide cognitive assessment in addition to special tasks to detect occurrence of CI and ED phenomena. Both ED and CI phenomena were present in more than half of the sample. Logistic regression analyses revealed that both ED and CI phenomena were significantly associated with poor scores on frontal neuropsychological tests. Although ED and CI often co-occurred, 3/12 patients with CI did not show ED, and 5/18 patients with ED did not show CI. A logistic regression model showed that the presence of ED was not significantly associated to CI. CI and ED are associated to progressive derangement of frontal functions in bvFTD. However, specific frontal dysfunctions might explain the occurrence of either phenomenon in isolation. (JINS, 2015, 21, 1–7)