Physical Activity and Exercise Addiction During the Covid-19 Pandemic in Italy.

Severe restrictive measures were implemented globally to limit the spread of the Covid-19 pandemic leading to significant lifestyle changes and impacting on both the physical and the mental health of citizens. Caught by the fear of getting sick, some individuals have adopted behaviors which favored the development of exercise addiction (EA). Our aim was to evaluate physical activity habits and the risk of EA in the general Italian population during phase 1 of the lockdown. The role of appearance anxiety (AA), self-compassion, and use of performance and image enhancing drugs (PIEDs) as predictors of EA development were investigated. A comparison between physically active subjects with the inactive ones was also included. Between April and May 2020, an online survey was conducted across Italy. Nine hundred thirty-six answers were collected. The rate of EA in the physically active sample (782 subjects) was 4.1%. The physically active group showed higher SCS scores and a greater use of PIEDs. Of the physically active participants, 84.2% reported variations in their fitness routine. Perceived benefit of exercising resulted significantly higher in those with EA. Subjects with EA reported stronger motivation in engaging in physical activity as for "physical wellness," "psychological well-being," and "sexual attractiveness and confidence in relationship." A higher level of AA, a lower level of self-compassion, and a higher perceived benefit of exercising during lockdown were all significant predictors for the presence of EA. Our findings suggest that the fear of getting sick from Covid-19, combined with radical changes in the lifestyles induced by the lockdown and individual personological characteristics, can favor the development of EA and related phenomena in the general population.

The impact of the SARS-COV2 infection on the disorder of consciousness rehabilitation unit.

BACKGROUND AND OBJECTIVE: Disorders of consciousness include coma (cannot be aroused, eye remain closed), vegetative state-VS (can appear to be awake, but unable to purposefully interact) and minimally conscious state-MCS (minimal but definite awareness). The objective of this study is to assess the impact of the SARS-CoV-2 infection on the Disorder of Consciousness (DOC) Rehabilitation Unit. METHODS: This is a retrospective, longitudinal, descriptive, observational, pilot study. We consecutively enrolled 18 patients (age range: 40-72 years, 9 females and 9 males), from three to five months after a brain injury. They were grouped into VS (n = 8) and MCS (n = 10). A confirmed case of COVID-19 was defined as a positive result on high-throughput sequencing or real-time reverse-transcription polymerase chain reaction analysis of throat swab specimens. We collected data of lung Computed Tomography (CT) and laboratory exams. DOC patients who were positive for SARS-CoV-2 were classified into severe and no severe infected group, according to the American Thoracic Society guidelines. RESULTS: A total of 18 hospitalized patients with (16) and without confirmed (2) SARS-CoV-2 infection were included in the analysis. After one month, a follow-up clinical evaluation reported that one patient died, one patient was transferred from Covid Unit to Emergency Unit and 3 patients were resulted negative to double swab and they returned to Rehabilitative Unit. Significant differences were reported about hypertension, cardiac disease and respiratory problems between the patients with severe infection and patients without severe infection (P< 0.001). The laboratory findings, such as blood cell counts (P < 0.001), C-reactive protein, D-dimer, potassium and vitamin D levels, seemed to be considered as useful prognostic predictors. CONCLUSIONS: To our knowledge, this is the first longitudinal study on a sample of chronic DOC patients affected by SARS-CoV-2. This study may offer important new clinical information on COVID-19 for management of DOC patients. Our findings showed that for the subjects with severe infection due to COVID-19, rapid clinical deterioration or worsening could be associated with clinical and laboratory findings, which could contribute to high mortality rate. During the COVID-19 epidemic period, the clinicians should consider all the reported risk factors to avoid delayed diagnosis or misdiagnosis and to prevent the infection transmission in DOC Rehabilitation Unit.

The relationship between body image and emotional and cognitive impairment after brain damage: A preliminary study.

INTRODUCTION: The image of one's own body derives from experimentation of one's own body pattern. The emotional experience can lead to a real or distorted self-representation. After brain damage, a disorder of body image is frequent. The purpose of this study was to investigate the role of body image following acquired brain injury (ABI). METHODS: Forty-six hospitalized patients were enrolled and subdivided into two groups depending on the etiology of the damage: traumatic or vascular. For each group, we considered their cognitive level and mood. Patients underwent a broad battery of tests to investigate different domains: Montreal Cognitive Assessment (MoCA); Beck's Depression Inventory (BDI-II); Hamilton Rating Scale for Anxiety (HAM-A); Clinical Insight Rating Scale (CIRS); Body Image Scale (BIS); Human Figure Drawing (HFD). The latter was used to assess the implicit body image of each patient. RESULTS: Both groups showed a significant relationship between BDI-II and BIS. A positive correlation was found between BIS and HAM-A, but only in the traumatic group. We showed a positive correlation between MoCA and HFD. In addition, we observed some subitems of MoCA as predictive variables in HFD, which differ in the two groups. In a traumatic group, the visuospatial domain is predictive in HFD, as well as age of patients' and education. In the vascular groups, orientation, naming, abstraction, and language domains are instead predictive. CONCLUSIONS: The results confirm the crucial role of the cognitive level and mood on self-perception.

The psychometric measures to assess aggressive dimension following traumatic brain injury: A review.

BACKGROUND: higher level of aggression and antisocial behavior are frequent following head trauma, due to specific brain alterations. Many tests are used to assess this aspect. A descriptive review was conducted on the main tests used to detect the appearance of aggressive dimensions following traumatic brain injury. REVIEW SUMMARY: we searched on PubMed and Web of Science databases and screening references of included studies and review articles for additional citations. From initial 723 publications, only 7 met our search criteria. Findings showed that various psychometric tools are used to assess aggressiveness and its subdomains, following head trauma. CONCLUSIONS: further investigation are necessary to clarify whether these tools ensure a reliable diagnosis in order to make an early intervention and reduce violent behavior and its development.

Role of neurorehabilitative treatment using transcranial magnetic stimulation in disorders of consciousness.

Disorders of consciousness (DOC) result from brain injuries that cause functional changes in vigilance, awareness and behaviour. It is important to correctly diagnose DOC so that the most appropriate rehabilitation treatments can be initiated. Several studies in DOC patients have demonstrated that repetitive transcranial magnetic stimulation (rTMS) has an important role to play in the recovery of consciousness as highlighted by monitoring clinical scale scores. Although studies indicate that rTMS can be used to aid recovery, it is not combined with other rehabilitative cognitive treatments. As of December 2018, there have been no studies published that combined DOC cognitive rehabilitation with TMS. This current review describes the use of rTMS as a form of non-invasive brain stimulation, as distinct from its use as a tool to investigate residual cortical activity, in terms of its possible therapeutic effects including cognitive rehabilitation. Literature searches were undertaken to identify all relevant studies. The available evidence suggests that rTMS may have an important role to play in in monitoring brain function during recovery and making other intensive rehabilitation treatments more effective, such as sensorial stimulations and cognitive training in patients after a severe acquired brain injury. Further research is required to establish the usefulness of rTMS treatment in DOC rehabilitation.

How personality traits affect functional outcomes in patients with multiple sclerosis: A scoping review on a poorly understood topic.

Personality is an important variable when explaining individual differences in disease acceptance, coping styles and psychological well-being. Personality changes, such as social inadequacy, disinhibition, apathy, emotional lability, and impulsivity, have been reported in many patients with multiple sclerosis (MS). This review sought to assess the role of personality traits in people with MS, focusing on how this may affect the patient's outcome. Studies were identified by searching on PubMed, Web Of Science and Cochrane databases. Our review shows that the personality traits commonly found in MS are often dysfunctional. In particular, it has been suggested that people with MS present with lower levels of conscientiousness, extraversion and agreeableness, as well as higher levels of neuroticism than healthy controls. These personality traits negatively affect cognitive domains, mood, and psychological well-being. As personality may affect the clinical manifestations and disabilities of patients with MS, personality assessment should be an integral part of the management of the disease, in order to achieve better functional outcomes.

Factors related to cognitive reserve among caregivers of severe acquired brain injury.

Stroke is one of the severe cause of motor and cognitive disabilities. These type of disabilities occurred a strong impact on whole family system. Caregiver burden may determine in relatives of patients with brain injury a decreasement of mental and physical health. The present study aims to better clarify the mechanism through which chronic stress influence caregivers' cognitive functioning and how the psychological and cognitive resources may represent as a predictive factor. Caregivers were submitted to neuropsychological tests that evaluated level of mental health ad level of burden. Our results showed a significant correlation between cognitive reserve and self-efficacy skills in health care of patients. Findings suggested that the caregiver burden and the level of general distress influenced the cognitive performance. An improvement of cognitive functions is associated with a reduction of self-efficacy skills, causing a caregiver burden improvement.

The role of mind theory in patients affected by neurodegenerative disorders and impact on caregiver burden.

BACKGROUND: Theory of Mind (ToM) is defined as the ability to understand mental and emotional state. This ability is assessed also in neurodegenerative disease. Few studies have investigated the impact that social cognition of patients could have on caregiver burden. The aim of this study was to investigate a possible correlation in level of social cognition impairment between patients with different neurodegenerative disorders and their caregivers with possible impact on caregivers burden. METHODS: we enrolled 48 patients with dementia divided in different groups: Fronto-Temporal Dementia (FTD), Alzheimer Disease (AD), and Mild Cognitive Impairment (MCI) and also the three groups of their respective caregivers. All subjects were submitted to ToM tests, and the caregiver groups also to Caregiver Burden Inventory (CBI) to evaluate level of burden. RESULTS: Our results showed that ToM was more impaired in FTD patients and in their caregivers In addition, FTD group showed more impaired performances in tasks related to emotional skills. CONCLUSIONS: We suggested that ToM impairment of patients are related to ToM impairment of caregivers with differences of scores in caregiver groups. The caregiver difficulties to understand, attribute and describe emotional and mental states of their relatives develop distress and inability in burden management and disorders relative to neurodegenerative disease.

Mindfulness interventions and pain management in a patient with encephalomyelitis.

Chronic pain is considered a common disabling disease, frequently related to a high comorbidity with anxiety and depression. Several psychological techniques have demonstrated to be effective in the treatment of chronic pain, in particular, mindfulness-based interventions (MBIs) seem to reduce pain acting on self-regulatory individual's ability. In addition, this approach could develop cognitive strategies to decrease impulsivity. We selected a case of a patient with encephalomyelitis and spastic tetraparesis to assess the application and effectiveness of MBIs to reduce pain perception, improve anxiety and depressive symptoms. Our treatment showed a reduction in pain perception, and an improvement in anxious and depressive symptoms. In conclusion, MBIs could be useful to relieve disorders related to pain in neurological patients.

Thought disorder in atypical schizophrenia-like psychosis after stroke: analysis of clinical cases.

Formal thought disorder refers to disorganized thinking and it represents a hallmark of schizophrenia and psychosis. Psychosis is a rare complication after stroke. We described two cases of female patients, who developed an atypical schizophrenia-like psychosis post-stroke, characterized by formal thought disorder, hallucinations, and delusion. Cerebrovascular disease affected the right temporal lobe, areas devoted to modulation of higher order cognitive processes. To date, the relation between stroke and psychosis remain unclear, maybe due to the involvement of a complex brain networks. However, the high impact of this disorder on physical, psychological and social wellbeing suggests the importance of improving specific treatments.

A multidisciplinary approach to assess recovery of consciousness in a patient with moyamoya disease.

INTRODUCTION: Moyamoya disease (MMD) meaning "hazy puff of smoke" in Japanese is a rare chronic cerebrovascular syndrome characterized by progressive stenosis and occlusion of the internal carotid arteries (ICAs) anterior cerebral arteries (ACAs), and middle cerebral arteries (MCAs). METHODS: Our moyamoya patient with severely impaired cognitive and motor functions underwent a specific motor and neuropsychological rehabilitative treatments to assess the recovery of consciousness. RESULTS: Results obtained showed an improvement of clinical and neuropsychological examination. These findings highlighted the importance of an intensive rehabilitation techniques used in the care of disorders of consciousness patients. CONCLUSIONS: The use of sensory methods provides advantages for the rehabilitation. In fact, in this study, we showed a correlation between sensory stimulation and changes in patient's clinical status.

Qualitative Analysis of Mini Mental State Examination Pentagon in Vascular Dementia and Alzheimer's Disease: A Longitudinal Explorative Study.

BACKGROUND: Vascular dementia and Alzheimer's disease are the most diffuse forms of dementia. Sometimes, they are difficult to distinguish due to overlaps in symptomatology, pathophysiology, and comorbidity. Visual constructive apraxia is very common in dementia and impairment in these abilities can provide clinical information for differential diagnosis. MATERIALS AND METHODS: All patients underwent Mini Mental State Examination (MMSE) at basal visit (T0) and after 1 year (T1). We analyzed differences in Qualitative Scoring Method for the Pentagon Copying Test and we explored the visual constructive apraxia evolution in these 2 types of dementia. RESULTS: In intragroup analysis, we found a significant difference in each group between T0 and T1 in MMSE score (P < .001) and total qualitative scores (P < .001). In intergroup analysis, at T0, we found significance difference in total qualitative scores (P < .001), in numbers of angles (P = .005), in distance/intersection (P < .001), in closure/opening (P = .01), in rotation (P < .001), and in closing-in (P < .001). At T1, we found significance difference in total qualitative scores (P < .001), in particular, in numbers of angles (P < .001), in distance/intersection (P < .001), in closure/opening (P < .001), in rotation (P < .001), and in closing-in (P < .001). The total score showed the highest classification accuracy (.90, 95%CI = .81-0.96) in differentiating patients with Alzheimer's disease from patients with vascular dementia. The optimal threshold value was k = 5. with .84 (95%CI = .69-0.93) sensitivity and .81 (95%CI = .64-0.93) specificity. CONCLUSION: Patients with vascular dementia showed more accuracy errors and graphic difficulties than patients with Alzheimer's disease. Qualitative analysis of copy provided a sensitive measure of visual constructive abilities in differentiating dementias, underlining a particularly vulnerability of visuoconstructive functions in vascular dementia compared with Alzheimer's disease.

Augmentative and Alternative Communication Effects on Quality of Life in Patients with Locked-in Syndrome and Their Caregivers.

BACKGROUND: The aim of this study was to evaluate the impact of the augmentative and alternative communication system on anxiety and depression performances and the quality of life (QoL) of patients who have the locked-in syndrome (LIS) and that of their caregivers. METHOD: We enrolled 15 patients and their principal caregivers. The assessment consisted of the administration of the employed Short Form-36 Questionnaire for the assessment of QoL, the Hamilton Anxiety Rating Scale (HAM-A) for anxiety, and the Beck Depression Inventory for depression. RESULTS: We compared the clinical test at baseline (T0) and after 3 months (T1) for each group (patients and caregivers). In the patients group, we observed a significant difference in all clinical test scores. In the caregivers group, we observed a significant difference for HAM-A (P = .003), vitality (P < .001), social activity (P < .001), social role functioning (P < .001), and emotional role functioning (P < .001) and no significant differences for other clinical scores. CONCLUSION: The possibility of being able to communicate allows patients with the LIS to recuperate a affective contact with their caregivers, improving global family atmosphere.

Evolution of psychological condition in caregivers of patients with disorders of consciousness: a longitudinal study.

The aim of this study is to evaluate mood disorders and needs in caregivers of disorders of consciousness (DOC) patients during the admission to Neurorehabilitation Unit. A total of 80 caregivers was enrolled and divided in two groups (caregivers of vegetative state-VS patients and caregivers of minimally conscious state-MCS patients). Paired sample t tests were carried out to test differences between baseline observation (T0) and after 6 months (T1). Caregivers of VS patients showed an improvement between T0 and T1 especially, in vitality, mean health, Beck Depression Inventory (BDI-II), Spielberger State-Trait Anxiety Inventory-Y (STAI-Y), Prolonged Grief Disorder (PG 12) and Caregiver Needs Assessment (CNA). On the other hand, caregivers of MCS patients showed a significant improvement in: BDI II, STAI Y and CNA. These data confirmed that the presence of psychological problems, the quality of life and the psychological wellbeing of caregivers of DOC patients improved over the time.