The Effects of Home Automation on Personal and Social Autonomies in Spinal Cord Injury Patients: A Pilot Study.

Background: Spinal cord injury (SCI) is a severe and progressive neurological condition caused by trauma to the nervous system, resulting in lifelong disability and severe comorbidities. This condition imposes serious limitations on everyday life, interfering with patients' social lives and compromising their quality of life, psychological well-being, and daily living activities. Rehabilitation is essential to helping SCI patients gain more independence in their daily routines. Home automation (HA) systems provide personalized support to users, allowing them to manage various aspects of their living environment, promoting independence and well-being. This study aims to demonstrate the efficacy of an HA system in enhancing personal and social autonomies in SCI patients, resulting in improved cognitive function and reduced anxiety-depressive symptoms compared to traditional training. Methods: We enrolled 50 SCI patients undergoing neurorehabilitation at IRCCS Centro Neurolesi (Messina, Italy). These patients were randomly assigned to one of two groups: a control group (CG) and an experimental group (EG). The CG received traditional training, while the EG underwent HA training. We evaluated the patients before (T0) and after (T1) rehabilitation using various scales, including the Montreal Cognitive Assessment (MoCA), the Beck Depression Inventory (BDI), the Hamilton Rating Scale for Anxiety (HRS-A), the 12-Item Short-Form Survey (SF-12), the Functional Independence Measure (FIM), Activities of Daily Living (ADL), Instrumental Activities of Daily Living Scale (IADL), and the EQ-5D-5L. Results: The effect of the experimental treatment showed an improvement in all patients test scores in the EG, especially regarding cognitive functions, mood disorders, activities of daily living, and quality of life. Conclusion: Our findings suggest that HA may be effective in improving daily autonomy and, in turn, alleviating mood disorders and enhancing psychological well-being.

The Lack of Ad Hoc Neuropsychological Assessment in Adults with Neurofibromatosis: A Systematic Review.

Background: Neurofibromatosis Type 1 (NF1) is a genetic autosomal dominant disorder that affects both the central and peripheral nervous systems. Children and adolescents with NF1 commonly experience neuropsychological, motor, and behavioral deficits. The cognitive profile hallmark of this disorder includes visuospatial and executive function impairments. These cognitive disorders may persist into adulthood. This study aims to analyze previous research studies that have described cognitive dysfunctions in adults with NF1. The purpose of this analysis is to review the neuropsychological and psychological assessment methods used. Methods: A total of 327 articles were identified based on the search terms in their titles and abstracts. The evaluation was conducted by scrutinizing each article's title, abstract, and text. Results: Only 16 articles were found to be eligible for inclusion based on the pre-defined criteria. The selected studies primarily focus on the development of diagnostic protocols for individuals with NF1. Conclusions: The management of NF1 disease requires a multidisciplinary approach to address symptoms, preserve neurological functions, and ensure the best possible quality of life. However, cognitive impairment can negatively affect psychological well-being. This study suggested that cognitive functions in NF1 patients were not tested using specific measures, but rather were evaluated through intelligence scales. Additionally, the findings revealed that there is no standardized neuropsychological assessment for adults with NF1. To address this gap, it would be helpful to create a specific neuropsychological battery to study cognitive function in NF1 patients during clinical studies. This battery could also serve as a tool to design models for cognitive rehabilitation by using reliable and sensitive measures of cognitive outcomes.

Applications of Artificial Intelligence in the Neuropsychological Assessment of Dementia: A Systematic Review.

In the context of advancing healthcare, the diagnosis and treatment of cognitive disorders, particularly Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD), pose significant challenges. This review explores Artificial Intelligence (AI) and Machine Learning (ML) in neuropsychological assessment for the early detection and personalized treatment of MCI and AD. The review includes 37 articles that demonstrate that AI could be an useful instrument for optimizing diagnostic procedures, predicting cognitive decline, and outperforming traditional tests. Three main categories of applications are identified: (1) combining neuropsychological assessment with clinical data, (2) optimizing existing test batteries using ML techniques, and (3) employing virtual reality and games to overcome the limitations of traditional tests. Despite advancements, the review highlights a gap in developing tools that simplify the clinician's workflow and underscores the need for explainable AI in healthcare decision making. Future studies should bridge the gap between technical performance measures and practical clinical utility to yield accurate results and facilitate clinicians' roles. The successful integration of AI/ML in predicting dementia onset could reduce global healthcare costs and benefit aging societies.

Smartphone-Based Cognitive Telerehabilitation: A Usability and Feasibility Study Focusing on Mild Cognitive Impairment.

The implementation of cognitive health apps in patients with mild cognitive impairment (MCI) is challenging because of their cognitive, age, and other clinical characteristics. In this project, we aimed to evaluate the usability and feasibility of the Rehastart app tested in MCI patients. Eighteen subjects affected by MCI due to neurodegenerative disorders (including Parkinson's disease, multiple sclerosis, and amnestic/multidomain MCI) and eighteen healthcare professionals were recruited to this study. Patients were registered on the app by clinicians and they were assigned a protocol of specific cognitive exercises. The recruitment was conducted in the period between March and June 2023. The trial testing of the app consisted of three sessions per week for three weeks, with each session lasting about 30 min. After three weeks, the participants as well as medical personnel were invited to rate the usability and feasibility of the Rehastart mobile application. The instruments employed to evaluate the usability and feasibility of the app were the System Usability Scale (SUS), The Intrinsic Motivation Inventory (IMI) and the Client Satisfaction Questionnaire (CSQ). We did not find statistically significant differences on the SUS (p = 0.07) between healthcare professionals and patients. In addition, we found promising results on subscales of the Intrinsic Motivation Inventory, suggesting high levels of interest and enjoyment when using the Rehastart app. Our study demonstrated that smartphone-based telerehabilitation could be a suitable tool for people with MCI due to neurodegenerative disorders, since the Rehastart app was easy to use and motivating for both patients and healthy people.

Paving the Way for Predicting the Progression of Cognitive Decline: The Potential Role of Machine Learning Algorithms in the Clinical Management of Neurodegenerative Disorders.

Alzheimer's disease (AD) is the most common form of neurodegenerative disorder. The prodromal phase of AD is mild cognitive impairment (MCI). The capacity to predict the transitional phase from MCI to AD represents a challenge for the scientific community. The adoption of artificial intelligence (AI) is useful for diagnostic, predictive analysis starting from the clinical epidemiology of neurodegenerative disorders. We propose a Machine Learning Model (MLM) where the algorithms were trained on a set of neuropsychological, neurophysiological, and clinical data to predict the diagnosis of cognitive decline in both MCI and AD patients. METHODS: We built a dataset with clinical and neuropsychological data of 4848 patients, of which 2156 had a diagnosis of AD, and 2684 of MCI, for the Machine Learning Model, and 60 patients were enrolled for the test dataset. We trained an ML algorithm using RoboMate software based on the training dataset, and then calculated its accuracy using the test dataset. RESULTS: The Receiver Operating Characteristic (ROC) analysis revealed that diagnostic accuracy was 86%, with an appropriate cutoff value of 1.5; sensitivity was 72%; and specificity reached a value of 91% for clinical data prediction with MMSE. CONCLUSION: This method may support clinicians to provide a second opinion concerning high prognostic power in the progression of cognitive impairment. The MLM used in this study is based on big data that were confirmed in enrolled patients and given a credibility about the presence of determinant risk factors also supported by a cognitive test score.

Traumatic Brain Injury and Related Antisocial Behavioral Outcomes: A Systematic Review.

Background and Objectives: Higher level of aggression and antisocial behavior have been found in the period following head trauma. These changes are attributable to specific brain alterations that generally involved frontal lobe, insula and limbic system. A descriptive review was conducted on the specificity of aggressive behavior in relation to traumatic brain injury by evaluating numerous variables, focusing on age at the time of trauma and neuroimaging studies. Materials and Methods: We searched on PubMed and the Web of Science databases to screen references of included studies and review articles for additional citations. From an initial 738 publications, only 27 met the search criteria of describing the relationship between aggression, brain alterations and traumatic brain injury. Results: These findings showed that traumatic brain injury (TBI) is related to changes in behavior, personality and mood. Conclusions: The development of aggressive and criminal behavior is associated with multiple factors, including the etiology of injury, environmental, psychosocial and personality factors and age at the time of trauma.

The Impact of Non-Motor Symptoms on Quality of Life in Cervical Dystonia.

Cervical dystonia (CD) is characterized by cranial muscle overactivity leading to abnormal intermittent or continuous posturing of the head. Nowadays, the treatment of patients suffering from this condition focuses principally on the motor component of the disorder, certainly the invaliding part; however, it leaves out the non-motor one that has a similarly invalidated effect on the quality of the subject's life. This review was conducted on studies investigating the impact of non-motor symptoms on levels of quality of life. We searched on the PubMed, EMBASE and Web of Science databases and screening references of included studies and review articles for additional citations. From an initial 150 publications, we included only five studies that met the search criteria. The results showed that anxiety, depression, pain and sleep quality have a great influence on patients' health and on the outcome of the disease. Future studies should focus more on investigating the non-motor components of CD as an integral part of the clinical management of dystonic patients in order to improve their well-being.

Cervical Artery Dissection and Patent Foramen Ovale in Juvenile Stroke: Causality or Casuality? A Familiar Case Report.

Cervical artery dissection (CAD) and Patent Foramen Ovale (PFO) are important causes of stroke in young patients. Although PFO is considered an independent risk factor for cerebral infarction in young adults with cryptogenic stroke, other concomitant causes may be necessary to cause brain injury. PFO could be a predisposing factor of stroke through several mechanisms including paradoxical embolism from a venous source, thrombus formation in atrial septum, or atrial arrhythmias causing cerebral thromboembolism. The pathophysiology of CAD is poorly understood and includes both constitutional and environmental factors. A causal association is often difficult to establish, as other predisposing factors may also play a role in CAD etiopathogenesis. We present a family with ischemic stroke (a father and his three daughters), in which the two different stroke causes are present. We hypothesized that a paradoxical embolism caused by PFO, associated with arterial wall disease, in the presence of a procoagulant state, could produce arterial dissection and then stroke.

The Role of Telemedicine in the Treatment of Cognitive and Psychological Disorders in Parkinson's Disease: An Overview.

BACKGROUND: This literature review evaluates the use and efficacy of telemedicine in cognitive and psychological treatment in Parkinson's disease. METHODS: Studies performed between 2016 and 2021 that fulfilled inclusion criteria were selected from PubMed, Scopus, Cochrane, and Web of Science databases. All articles were evaluated by title, abstract, and text. All studies that examined the cognitive and psychological/psychotherapy treatment of patients with Parkinson's disease by telemedicine were included. RESULTS: Telehealth improved cognitive status and emotional/behavioral disorders in this population, and had positive effects on the patients' and caregivers' quality of life. CONCLUSIONS: Our literature review supports the development and efficacy of cognitive and psychological treatment with telemedicine, but the methodology of the study must be reviewed considering its limitations so as to highlight the benefits and risks of treatment via telemedicine.

Gender and Neurosteroids: Implications for Brain Function, Neuroplasticity and Rehabilitation.

Neurosteroids are synthesized de novo in the nervous system; they mainly moderate neuronal excitability, and reach target cells via the extracellular pathway. The synthesis of neurosteroids occurs in peripheral tissues such as gonads tissues, liver, and skin; then, because of their high lipophilia, they cross the blood-brain barrier and are stored in the brain structure. Neurosteroidogenesis occurs in brain regions such as the cortex, hippocampus, and amygdala by enzymes necessary for the in situ synthesis of progesterone from cholesterol. Neurosteroids could be considered the main players in both sexual steroid-induced hippocampal synaptic plasticity and normal transmission in the hippocampus. Moreover, they show a double function of increasing spine density and enhancing long term potentiation, and have been related to the memory-enhancing effects of sexual steroids. Estrogen and progesterone affect neuronal plasticity differently in males and females, especially regarding changes in the structure and function of neurons in different regions of the brain. Estradiol administration in postmenopausal women allowed for improving cognitive performance, and the combination with aerobic motor exercise seems to enhance this effect. The paired association between rehabilitation and neurosteroids treatment could provide a boosting effect in order to promote neuroplasticity and therefore functional recovery in neurological patients. The aim of this review is to investigate the mechanisms of action of neurosteroids as well as their sex-dependent differences in brain function and their role in neuroplasticity and rehabilitation.

The effect of Computer Assisted Rehabilitation Environment (CAREN) in cognitive impairment and coping strategies in Parkinson's disease: a preliminary study.

Parkinson's disease is a neurodegenerative disorder characterized by different motor, vegetative, behavioral, and cognitive impairments, with worsening quality of life. Virtual reality devices have given promising results in neurorehabilitation as they can provide multisensory stimulation in a realistic environment. This study aims to test the efficacy of virtual reality training by using Computer Assisted Rehabilitation Environment in cognitive impairment in a sample of PD. 31 patients affected by PD were enrolled. All PD patients underwent 24 sessions of Computer Assisted Rehabilitation Environment training. The participants were assessed at baseline (T0) and after two months (T1). Our results suggested that Computer Assisted Rehabilitation Environment training may be effective in the cognitive and emotional domains, particularly by improving executive function, anxiety, and depressive symptoms. These changes have helped to improve self-efficacy and coping strategies. These results indicate greater cognitive and physical effort to overcome stressors. Our results show that Computer Assisted Rehabilitation Environment training was beneficial in improving cognitive functions. Longer duration training may be especially beneficial for patients with mild cognitive impairment. Our findings open the door to tailored personalized treatments based on the patient's motor and cognitive profiles.

Importance of telemedicine in mild cognitive impairment and Alzheimer disease patients population during admission to emergency departments with COVID-19.

In March 2020, the World Health Organization declared a global pandemic due to the new coronavirus SARS-CoV-2, and several governments have planned a national quarantine to control the spread of the virus. Acute psychological effects during hospitalization in frail elderly individuals with special needs, such as patients with dementia, have been little studied. The greatest distress manifested by these kinds of patients was isolation from their families during hospitalization. Thus, structured video call interventions were carried out to family caregivers of patients diagnosed with dementia during their hospitalization in the COVID-19 ward. The purpose of this quasi-experimental study was to assess changes in cognitive and behavioral symptoms in both patients and caregivers. All study participants underwent psychological assessments. Specifically, the psychological well-being states of patients and their caregivers were measured at admission (T0) and discharge (T1) using psychometric tests and clinical scales. Each participant received an electronic device to access video calls in addition meetings were scheduled with the psychologist and medical team to keep caregivers updated on the health status of their relatives. A psychological support and cognitive rehabilitation service was also provided. Significant differences were found in all clinical variables of the caregiver group. Results showed a significant relationship in the quality of life score between the patient and caregiver groups. The results of this study has highlighted the importance of maintaining significantly effective relationships during the hospitalization period of patients admitted to COVID wards.

Hypnotherapy as a Nonpharmacological Treatment for the Psychological Symptoms of Multiple Sclerosis.

Context: Stress and chronic pain are the factors that most influence the quality of life and well-being of people with MS, and 90% of adults with MS suffer from persistent fatigue. These symptoms can be associated with other disorders such as depression, and drug treatments provide inadequate comfort for most people with them. Objective: The study intended to examine the impact of hypnosis and hypnotherapy in the management of symptoms of people with multiple sclerosis (MS), such as stress, chronic pain, an inferior quality of life, and a lack of psychological well-being. Design: The research team performed a systematic narrative review by searching the PubMed and Web of Science databases, including review articles and other studies for additional citations. Setting: The study was conducted at our Scientific Institute for Research (IRCCS) in Messina. Results: Only 14 of 121 publications met the inclusion criteria and were selected. Hypnotic treatment is an effective therapy that has beneficial impacts on the intensity of perceived pain, psychological well-being, mood disorders, and fatigue, and in addition, it significantly improves physical functioning in MS patients. The same effects haven't been obtained with other nonpharmacological techniques. Conclusion: Hypnosis is an appropriate psychological therapy for the management of MS patients' symptoms.

Neuropsychological effects of COVID-19: A review.

OBJECTIVE: The purpose of this review is to examine review literature on the psychological effects of the COVID-19 pandemic. METHODS: Studies were identified by an online search of the PubMed database. We selected studies published from January to May 2020 (during the COVID-19 emergency). RESULTS: We found that psychological effects of COVID-19 remain serious among the most of the population, in particular for people with mental disorders, adolescents, healthcare workers, and the general population that experienced high levels of stress, anxiety, and depression symptoms, with possible long-term psychological implications. CONCLUSION: Findings revealed that living in urban areas, having economic stability, and living with parents were protective factors against anxiety for youth groups, whereas a risk factor was represented by the presence of COVID-19 infection that involved family members.

Cognitive and Speech Rehabilitation in a Patient Affected by Takotsubo Cardiomyophathy: A Case Report.

Background and Objectives: Takotsubo Syndrome (TS) constitutes one of the most recent clinical realities in modern cardiology. It is clinically similar to the acute coronary syndrome, in the absence of obstructive coronary artery disease. Case Presentation: We described a case of a female patient affected by TS and left ventricular apical thrombus. Several studies described the cardiological syndrome, overlooking the neuropsychological and psychological outcomes. We aimed to assess the advantages of an integrated, multidisciplinary and multifunctional rehabilitation. Conclusions: This specific training contributed to reducing the tolerance to frustration given by her communication's difficulty. It has favored a good therapeutic alliance and a good success of the psychotherapeutic path, guaranteeing the reduction of her anxious symptoms and an improvement in the emotive and relational status.

Humanoid Robot Use in Cognitive Rehabilitation of Patients with Severe Brain Injury: A Pilot Study.

Severe acquired brain injury (SABI) is a major global public health problem and a source of disability. A major contributor to disability after SABI is limited access to multidisciplinary rehabilitation, despite evidence of sustained functional gains, improved quality of life, increased return to work, and reduced need for long-term care. Twelve patients with a diagnosis of SABI were enrolled and equally divided into two groups: experimental and control. Patients in both groups underwent intensive neurorehabilitation according to the severity of their disabilities (motor, psycho-cognitive, and sensory deficits). However, in the experimental group, the treatment was performed by using a humanoid robot. At baseline, the two groups differed significantly only in Severe Impairment Battery (SIB) scores. Results showed that the experimental treatment had a higher effect than the traditional one on quality of life and mood. In conclusion, this pilot study provides evidence of the possible effects of relational and cognitive stimulation in more severely brain-injured patients.

Investigations of Personality Trait in Subacute Post-Stroke Patients: Some Preliminary Observations.

BACKGROUND AND OBJECTIVES: Personality change is an important psychiatric complication following stroke linked to severe affective dysregulation and behavioral alterations. METHODS: We investigated personality traits in 20 patients (age 45.37 ± 13.41 years) with subacute stroke submitted to rehabilitation training within 1-3 months after a first-onset stroke. All patients underwent psychological evaluation by using the Personality Inventory for DSM-5 for adults (PID-5), a specific instrument that enables traits (dimensions and facets) to be assessed by providing a personality profile, and the Inventory of Interpersonal Problems 47 (IIP-47), a brief and valid self-report measure for screening personality disorders. RESULTS: Personality change was identified by a positive correlation IIP-47 and PID-5 (r = 0.76; p = 0.03). Our patients, after a stroke, presented maladaptive personality traits associated with negative affect such as anxiety, emotional lability, and rigid perfectionism, and they reported interpersonal problems. These negative affective disorders correlated positively with cluster C personality disorders, including the avoidant, dependent, and obsessive compulsive personality disorders. CONCLUSION: Preliminary results show personality changes in stroke survivors. The evaluation of personality changes could be useful to improve the management of the patient's behavioral alterations in a familiar environment and permit the possibility of prevention of psychological distress of the patients and their respective caregivers.

Care models for mental health in a population of patients affected by COVID-19.

OBJECTIVE: Emergency psychological interventions are needed in patients with COVID-19. During the pandemic, psychological counseling services have been provided using online platforms to address adverse psychological impacts and symptoms in patients and the general population. We investigated the effects of telepsychotherapy on emotional well-being and psychological distress in patients affected by COVID-19. METHODS: Forty-five Sicilian patients who had contracted COVID-19 joined "Telecovid Sicilia" from March to June 2020. Participants completed self-assessment questionnaires and psychological testing to measure levels of anxiety, presence of depressive symptoms, and altered circadian rhythm with consequent sleep disorders and psychological distress. Individual telepsychotherapy services were provided for 1 hour, twice a week, for 16 sessions in total. RESULTS: We enrolled 45 patients (42.2% women). We found significant changes between baseline and the end of follow-up in all outcome measures, especially depression (χ2 (1) = 30.1; effect size [ES] = 0.82), anxiety (χ2 (1) = 37.4; ES = 0.91), and paranoid ideation (χ2 (1) = 5.6; ES = 0.35). The proportion of participants with sleep disorders decreased to 84.1% after intervention (χ2 (1) = 58.6; ES = 1.14). CONCLUSION: A telepsychotherapeutic approach showed promising effects on psychological symptoms, with significantly reduced patient anxiety and depression.

Normal pressure hydrocephalus: Neurophysiological and neuropsychological aspects: a narrative review.

ABSTRACT: Idiopathic normal pressure hydrocephalus (NPH) is a syndrome that affects elderly people and is characterized by excessive accumulation of cerebrospinal fluid in the brain ventricles. Diagnosis is based on the evaluation of clinical symptoms, which consists of a classic triad (Hakim triad), gait disturbances, cognitive impairment, and urinary incontinence. However, this complete triad is not always seen; therefore, it is difficult to make the diagnosis. NPH can be divided into primary or idiopathic NPH and secondary NPH. Diagnostic criteria for NPH remain a topic of discussion; however, the development of diagnostic techniques has brought new opportunities for diagnosis. The aim of this review is to present an overview of neurophysiological and neuropsychological approaches to support the clinical evaluation of patients with NPH and contribute to the differential diagnosis of NPH and dementia, as the clinical symptoms of NPH may resemble other neurodegenerative disorders.

Coping Strategies of Healthcare Professionals with Burnout Syndrome: A Systematic Review.

Background and Objectives: To evaluate the efficacy of coping strategies used to reduce burnout syndrome in healthcare workers teams. Materials and Methods: We used PubMed and Web of Science, including scientific articles and other studies for additional citations. Only 7 of 906 publications have the appropriate inclusion criteria and were selected. A PRISMA 2020 flow diagram was used. Results: The most common coping strategies that the literature studies showed were efficient, in particular social and emotional support, physical activity, physical self-care, emotional and physical distancing from work. Coping mechanisms associated with less burnout were also physical well-being, clinical variety, setting boundaries, transcendental, passion for one's work, realistic expectations, remembering patients and organizational activities. Furthermore, it was helpful to listen to the team's needs and preferences about some types of training. Conclusion: We suppose that the appropriate coping strategies employed in the team could be useful also in the prevention of psychological suffering, especially in contexts where working conditions are stressful. Studies about coping strategies to face burnout syndrome in healthcare workers should be increased.