Visuospatial Deficits Are Associated with Pisa Syndrome and not Camptocormia in Parkinson's Disease.

Background: Pisa syndrome (PS) and camptocormia (CC) are postural abnormalities frequently associated with Parkinson's disease (PD). Their pathophysiology remains unclear, but the role of cognitive deficits has been postulated. Objectives: To identify differences in the neuropsychological functioning of patients with PD with PS or CC compared with matched patients with PD without postural abnormalities. Methods: We performed a case-control study including 57 patients with PD with PS (PS+) or CC (CC+) and 57 PD controls without postural abnormalities matched for sex, age, PD duration, phenotype, and stage. Patients were divided into four groups: PS+ (n = 32), PS+ controls (PS-, n = 32), CC+ (n = 25), and CC+ controls (CC-, n = 25). We compared PS+ versus PS- and CC+ versus CC- using a neuropsychological battery assessing memory, attention, executive functions, visuospatial abilities, and language. Subjective visual vertical (SVV) perception was assessed by the Bucket test as a sign of vestibular function; the misperception of trunk position, defined as a mismatch between the objective versus subjective evaluation of the trunk bending angle >5°, was evaluated in PS+ and CC+. Results: PS+ showed significantly worse visuospatial performances (P = 0.025) and SVV perception (P = 0.038) than their controls, whereas CC+ did not show significant differences compared with their control group. Reduced awareness of postural abnormality was observed in >60% of patients with PS or CC. Conclusions: Low visuospatial performances and vestibular tone imbalance are significantly associated with PS but not with CC. These findings suggest different pathophysiology for the two main postural abnormalities associated with PD and can foster adequate therapeutic and prevention strategies.

Acupressure in insomnia and other sleep disorders in elderly institutionalized patients suffering from Alzheimer's disease.

BACKGROUND: Sleep disorders are very common in elderly institutionalized people with dementia and acupressure recently has been associated with conventional medicine in their treatment. AIMS: Exploring the effectiveness of acupressure for the treatment of insomnia and other sleep disturbances and we want to show that the acupressure treatment is feasible also in elderly resident patients. METHODS: We enrolled institutionalized patients suffering from Alzheimer's disease with mild cognitive impairment and insomnia. A daily acupressure on HT7 point (H7 Insomnia Control(®)) was performed for a 8-week period. We administered the following scales: the mini mental state examination, the global deterioration scale, the neuropsychiatric inventory, the state-trait-anxiety inventory, the activity daily living and the instrumental activity daily living, the global health quality of life, and the Pittsburgh sleep quality index. RESULTS: After receiving the acupressure treatment, patients saw a significant decrease of sleep disorders. The number of hours of effective sleep was perceived as increased. Furthermore, the time necessary to fall asleep decreased significantly and also the quality of sleep increased. Additionally, also the quality of life was bettered. Sedative drugs have been reduced in all patients involved in the study. CONCLUSIONS: Acupressure can be recommended as a complementary, effective, and non-intrusive method to reduce sleep disturbances in old resident patients affected by cognitive disorders. A limitation of the study is the small sample size. More studies are needed to further validate the results of our study.

Neuropsychiatric symptoms underlying caregiver stress and insight in Alzheimer's disease.

OBJECTIVE: Cluster analysis based on Alzheimer's disease (AD) neuropsychiatric profile demonstrated validity on caregiver burden, nursing-home placement and survival. The aims of our study were to explore the validity of this approach on caregiver burden, lack of insight and cognitive impairment and to examine the impact of neuropsychiatric profiles on these variables. METHOD: A data-driven approach (two-step cluster analysis) identified groups of patients based on similarities of their neuropsychiatric symptom profile, as assessed by the Neuropsychiatric Inventory (NPI). ANOVAs and chi(2) tests were used to compare groups with regard to continuous and categorical variables. Linear regressions tested the relationships between NPI and clinical variables. RESULTS: Psychotic/behavioral, depressive and minimally symptomatic clusters differed for caregiver burden and lack of insight. Patients in the minimally symptomatic cluster showed better insight than those in the depressive cluster. Caregivers of the psychotic/behavioral cluster experienced the highest burden. We found positive relationships between NPI and lack of insight in the depressive and minimally symptomatic clusters and between NPI and caregiver burden in all three clusters. Caregiver burden was influenced by the type of symptoms. CONCLUSIONS: The cluster analysis was valid for lack of insight and caregiver burden. Symptoms predominant on caregiver burden could become targets for therapy.

Spectral electroencephalogram analysis in hepatic encephalopathy and liver transplantation.

The aim of this study is to evaluate the role of spectral electroencephalogram (EEG) analysis ((S)EEG) in quantitating brain dysfunction in cirrhotic patients, showing conditions of minimal hepatic encephalopathy (HE), and determining the impact of orthotopic liver transplantation (OLT) on its correction. (S)EEG was compared with visual EEG ((V)EEG) in 44 cirrhotic patients waiting for OLT and 44 healthy controls. Eighteen patients had overt HE, and 26 patients had no apparent HE. Twenty-one transplant recipients were reexamined 6 months after OLT. Computerized (S)EEG was performed by mean dominant frequency (MDF) and the occipital alpha-theta ratio, expressed as its logarithmic transformation (LogR). All patients underwent psychometric assessment. MDF and LogR correlated significantly with Child-Pugh score (P <.05) and the presence of HE (P <.0001). (S)EEG and (V)EEG determined minimal HE in 8 (31%) and 6 (23%) of 26 patients without overt HE, respectively. (S)EEG did not correlate with age, sex, cause of liver disease, portal hypertension, or psychometric test results. MDF and LogR improved in many transplant recipients. LogR was significantly lower in OLT candidates who died before OLT compared with OLT survivors. In conclusion, (S)EEG provides reliable quantitative information to evaluate the degree of HE and appears more sensitive than (V)EEG to discriminate a subclinical stage of HE. The improvement in (S)EEG results observed in transplant recipients confirms the reversibility of bioelectric brain dysfunction with restoration of liver functions.