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  • 1
    Keywords: SURVIVAL ; MORTALITY ; OBESITY ; smoking ; REGRESSION-MODELS ; MASS INDEX ; OVERWEIGHT ; ALS PATIENTS ; NUTRITIONAL-STATUS ; HYPERMETABOLISM
    Abstract: OBJECTIVES: The aim of this study was to investigate for the first time the association between body fat and risk of amyotrophic lateral sclerosis (ALS) with an appropriate prospective study design. METHODS: The EPIC (European Prospective Investigation into Cancer and Nutrition) study included 518,108 individuals recruited from the general population across 10 Western European countries. At recruitment, information on lifestyle was collected and anthropometric characteristics were measured. Cox hazard models were fitted to investigate the associations between anthropometric measures and ALS mortality. RESULTS: Two hundred twenty-two ALS deaths (79 men and 143 women) occurred during the follow-up period (mean follow-up = 13 years). There was a statistically significant interaction between categories of body mass index and sex regarding ALS risk (p = 0.009): in men, a significant linear decrease of risk per unit of body mass index was observed (hazard ratio = 0.93, 95% confidence interval 0.86-0.99 per kg/m(2)); among women, the risk was more than 3-fold increased for underweight compared with normal-weight women. Among women, a significant risk reduction increasing the waist/hip ratio was also evident: women in the top quartile had less than half the risk of ALS compared with those in the bottom quartile (hazard ratio = 0.48, 95% confidence interval 0.25-0.93) with a borderline significant p value for trend across quartiles (p = 0.056). CONCLUSION: Increased prediagnostic body fat is associated with a decreased risk of ALS mortality.
    Type of Publication: Journal article published
    PubMed ID: 23390184
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  • 2
    Abstract: BACKGROUND/AIMS: Large epidemiological prospective studies represent an important opportunity for investigating risk factors for rare diseases such as Parkinson's disease (PD). Here we describe the procedures we used for ascertaining PD cases in the EPIC (European Prospective Investigation into Cancer and Nutrition) study. METHODS: The following three-phase procedure was used: (1) elaboration of a NeuroEPIC4PD template for clinical data collection, (2) identification of all potential PD cases via record linkage and (3) validation of the diagnosis through clinical record revision, in a population of 220,494 subjects recruited in 7 European countries. All cases were labelled with the NeuroEPIC4PD diagnoses of 'definite', 'very likely', 'probable', or 'possible' PD. RESULTS: A total of 881 PD cases were identified, with over 2,741,780 person-years of follow-up (199 definite, 275 very likely, 146 probable, and 261 possible). Of these, 734 were incident cases. The mean age at diagnosis was 67.9 years (SD 9.2) and 458 patients (52.0%) were men. Bradykinesia was the most frequent presenting motor sign (76.5%). Tremor-dominant and akinetic rigid forms of PD were the most common types of PD. A total of 289 patients (32.8%) were dead at the time of the last follow-up. CONCLUSIONS: This exercise proved that it is feasible to ascertain PD in large population-based cohort studies and offers a potential framework to be replicated in similar studies.
    Type of Publication: Journal article published
    PubMed ID: 26375921
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  • 3
    Abstract: Previous case-control studies have suggested a possible increased risk of Amyotrophic Lateral Sclerosis (ALS) with physical activity (PA), but this association has never been studied in prospective cohort studies. We therefore assessed the association between PA and risk of death from ALS in the European Prospective Investigation into Cancer and Nutrition. A total of 472,100 individuals were included in the analysis, yielding 219 ALS deaths. At recruitment, information on PA was collected thorough standardised questionnaires. Total PA was expressed by the Cambridge Physical Activity Index (CPAI) and analysed in relation to ALS mortality, using Cox hazard models. Interactions with age, sex, and anthropometric measures were assessed. Total PA was weakly inversely associated with ALS mortality with a borderline statistically significant trend across categories (p = 0.042), with those physically active being 33 % less likely to die from ALS compared to those inactive: HR = 0.67 (95 % CI 0.42-1.06). Anthropometric measures, sex, and age did not modify the association with CPAI. The present study shows a slightly decreased-not increased like in case-control studies-risk of dying from ALS in those with high levels of total PA at enrolment. This association does not appear confounded by age, gender, anthropometry, smoking, and education. Ours was the first prospective cohort study on ALS and physical activity.
    Type of Publication: Journal article published
    PubMed ID: 26968841
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  • 4
    ISSN: 1590-3478
    Keywords: Parkinson disease ; on-off phenomena ; cognitive performance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Sommario 10 pazienti affetti da Morbo di Parkinson, in terapia cronica con L-Dopa e con fluttuazioni della performance motoria non correlate alla somministrazione di L-Dopa (fenomeni on-off) sono stati valutati mediante alcuni tests neuropsicologici durante le fasi di on e off: Tests di attenzione (Toulouse-Pieron Test), di memoria (Digit Span; Reattivo di Rey, forma 1 e 2), di valutazione della Psicomotricità (Test del labirinto, Tempi di reazione semplici e complessi) e Test per la valutazione del tono dell'umore (Maudley Adjective Check List). La sintomatologia extrapiramidale è stata valutata mediante Webster Rating Scale. A fronte di importanti fluttuazioni della performance motoria tra fasi on e off, non abbiamo osservato significative modificazioni delle performances attentive, cognitive e del tono dell'umore
    Notes: Abstract 10 patients with Parkinson disease on long term levodopa therapy and with fluctuations in motor performance unrelated to drug administration (on-off phenomena) were assessed on the following neuropsychological tests during the on and off phases: tests of attention (Toulouse-Pieron), memory (Digit Span, Rey forms 1 and 2), psychomotor capacity (maze test, single and multiple choice reaction times) and mood (Maudley Adjective Check List). The extrapyramidal symptoms were assessed on the Webster Rating Scale. We found no significant differences in attention, cognitive performance or mood between the on and off phases despite large fluctuations in motor performance.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1590-3478
    Keywords: Key words Parkinsonism ; n-hexane ; Solvents
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Recently, some case-control studies and case reports have shown an association between solvent exposure and parkinsonisms. We present a 55-year-old male parkinsonian patient with chronic exposure to n-hexane for 17 years. The results of neurophysiological (electromyography, evoked potentials), neuroradiological (MRI) and neurophychological tests performed on the patient suggest a role of this solvent at the level of the central nervous system. Biological subceptibility to neurotoxic compounds is discussed briefly.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1590-3478
    Keywords: Parkinson disease ; hallucinations ; dementia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Sommario I fenomeni allucinatori rappresentano un evento piuttosto frequente nel corso del trattamento farmacologico del Morbo di Parkinson. Scopo di questo studio è stato quello di valutare i rapporti esistenti tra allucinazioni e deterioramento mentale e quindi le correlazioni fra tali fenomeni dispercettivi e le caratteristiche del profilo al test MMPI. In una popolazione di 304 pazienti ambulatoriali affetti da Morbo di Parkinson, seguiti presso il nostro centro, fenomeni allucinatori si erano verificati in 27 soggetti (8,88%). Deficits cognitivi rilevanti (Mini Mental State 〈18) erano presenti nei 17 dei 27 pazienti con pregresse allucinazioni (62,9%) e nell' 11,5% dei pazienti del resto della popolazione (32 casi su 277) (X2=55.16, p〈0.0001). Un gruppo di 9 paz. con pregresse allucinazioni e di 10 paz. di controllo senza allucinazioni, tutti privi di deficits cognitivi rilevanti, sono inoltre stati valutati mediante una batteria di tests neuropsicologici (Luria-Nebraska Neuropsychological Battery) (LNNB) ed un test di personalità (Minnesota Multiphasic Personality Inventory) (MMPI). A fronte di performances cognitive che non differivano significativamente fra i 2 gruppi, si sono registrate differenze significative nel profilo alle scale del MMPI. Da questo studio emerge una prevalenza di deterioramento mentale significativamente più elevata nei pazienti con allucinazioni pregresse. Inoltre viene discusso il significato delle differenze al MMPI sia dal punto di vista biochimico che da quello dei fattori di personalità. Questi dati suggeriscono infine il possibile uso del MMPI nei paz. parkinsoniani non deteriorati, come mezzo predittivo di insorgenza di allucinazioni in corso di terapia farmacologica.
    Notes: Abstract Hallucinations occur fairly frequently in the course of the pharmacological treatment of Parkinson disease. Our aim in this study was to assess first the relation between hallucinations and mental deterioration and second the correlation between the perception disorder and the profile on the Minnesota Multiphasic Personality Inventory (MMPI). Of 304 parkinsonian subjects followed as outpatients at our center 27 (8.88%) had had hallucinations and 17 of these presented marked cognitive deficits (Mini Mental State 〈18) (62.9%) compared with 32 of the other 277 patients (11.5%) (X2=55.16, p〈0.0001). A group of 9 patients who had had hallucinations and 10 controls who had not, all free from marked cognitive deficits, were assessed on the Luria-Nebraska Neuropsychological Battery (LNNB) and on the MMPI. The two groups did not differ significantly in respect of the LNNB but did in respect of the MMPI scales. On this evidence the frequency of mental deterioration is significantly higher in patients who have hallucinated. We discuss the meaning of the MMPI differences both from the biochemical angle and from that of personality factors. These data suggest that the MMPI might be useful for predicting hallucinations in undeteriorated parkinsonian patients on pharmacological therapy.
    Type of Medium: Electronic Resource
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  • 7
    Publication Date: 2018-03-30
    Description: Aim Providing an overview of the neuropsychological tests used in Italian memory clinics (defined as Centers for Cognitive Disorders and Dementias—CCDD in Italy) for the diagnosis of cognitive disorders and dementias. Methods A total of 501 CCDD, out of all 536 active CCDD, were surveyed between February 2014 and August 2015 to verify the characteristics of the centres who performed a comprehensive neuropsychological assessment (NPA), defined as the administration of at least one test for verbal and visual episodic memory, attention, constructional praxis, verbal fluency and executive functions (minimum core tests—MCTs), as part of the diagnostic process. Results A total of 45.7% of Italian CCDD performed a comprehensive MCT as part of the diagnostic process. The logistic regression model showed that the probability of including at least one psychologist in the team was higher in the CCDD that reported using a comprehensive NPA (OR 4.55; 95% CI 2.92 to 7.1), that CCDD in Southern Italy had a lower probability of using an MCT (OR 0.56; 95% CI 0.35 to 0.89) and that the use of an MCT was higher in university/Institute for Scientific Research and Healthcare CCDD (OR 10.97; 95% CI 3.85 to 31.25). Conclusion Almost half of the CCDD administered a set of MCTs; while the remaining centres only performed few tests or screening procedures. The neuropsychological tests used in Italian CCDD were comparable with those used in other European countries. Performing a comprehensive NPA remains the best way to assess and monitor cognitive deficits over time, thus further debate on the current status of NPAs in clinical practice is needed.
    Keywords: Open access, Neurology
    Electronic ISSN: 2044-6055
    Topics: Medicine
    Published by BMJ Publishing
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