Isolated, subtle, neurological abnormalities in neurologically and cognitively healthy aging subjects

Camarda, Cecilia; Torelli, Paola; Camarda, Rosolino; Battaglini, Iacopo; Gagliardo, Cesare; Monastero, Roberto

doi:10.1007/s00415-015-7716-5

Cited by 11 publications

(27 citation statements)

References 61 publications

(58 reference statements)

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“…Details of the inclusion and exclusion criteria of the CogItA study have been reported elsewhere. 20 Informed consent was obtained from all participants and relatives. The study was approved by the University Hospital ethics committee and complies with the declaration of Helsinki.…”

Section: Participantsmentioning

confidence: 99%

“…Many vascular risk factors (VRFs) and vascular diseases (VDs) were considered and assessed as reported elsewhere. 20,29 Since multiple VRFs and VDs often coexist, we created the VRF and VD summary scores indicating for each participant the sum of the individual VRFs and VDs that were concurrently present. APOE genotypes were determined by using standard methods.…”

Section: Baseline Clinical Assessmentmentioning

confidence: 99%

“…The functional status of participants was assessed through the ADL and the IADL scales. Cognitive functions were assessed using an extensive neuropsychological battery as reported elsewhere, 20,35 including the MMSE as test of global cognition and 12 tests to evaluate memory, attention, executive function, language, constructional ability, and visuospatial skill. Impaired cognitive domains were identified using a cut-off of 1.5 standard deviation (SD) 2 below the Italian normative data adjusted for age, sex, and education.…”

Section: Functional and Neuropsychological Assessmentsmentioning

confidence: 99%

“…Intimal-medial thickness (IMT) and stenosis of internal carotid arteries (SICAs) were assessed as reported elsewhere. 20 Participants had brain MRI on a 1.5T scanner (GE Signa HDxt, Milwaukee, WI, USA). Details of the image acquisition protocol have been published previously.…”

Section: Carotid Ultrasonography and Imaging Assessmentsmentioning

confidence: 99%

“…We have shown that neurologically and cognitively healthy (NCH) aging subjects frequently present at the routine neurological examination isolated, subtle neurological abnormalities (ISNAs) which do not have any immediate diagnostic relevance, cannot be attributed to any definite, overt neurological disease, are associated with atrophy of the caudate nuclei, and with parietal WMH and lacunes, and probably constitute a red flag for future cognitive decline given that they show poor performance in test evaluating global cognition, executive function, and language. 20 Past reports on neurological signs in MCI have primarily focused on extrapyramidal features, 21,22 while reports on signs other than extrapyramidal are sparse. Therefore, the aims of our study are: (1) to investigate the prevalence of ISNAs in the four MCI types and (2) to verify whether in the individual MCI types the probability of having ISNAs is differently associated with the topographical location of WMH and lacunes, periventricular WMH (WMH-PV), apolipoprotein E (APOE) ϵ4 allele, and with two linear measures of central atrophy, 12 i.e., the bicaudate ratio (BCr) as proxy of subcortical atrophy and the lateral ventricles to brain ratio (LVBr) as proxy of global brain atrophy.…”

Section: Introductionmentioning

confidence: 99%

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Isolated, Subtle Neurological Abnormalities in Mild Cognitive Impairment Types

Camarda

Pipia

et al. 2019

Can. J. Neurol. Sci.

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ABSTRACT:Background:Isolated, subtle neurological abnormalities (ISNA) are commonly seen in aging and have been related to cerebral small vessel disease (SVD) and subcortical atrophy in neurologically and cognitively healthy aging subjects.Objective:To investigate the frequency of ISNA in different mild cognitive impairment (MCI) types and to evaluate for each MCI type, the cross-sectional relation between ISNA and white matter hyperintensities (WMH), lacunes, caudate atrophy, and ventricular enlargement.Methods:One thousand two hundred fifty subjects with different MCI types were included in the analysis and underwent brain magnetic resonance imaging. WMHs were assessed through two visual rating scales. Lacunes were also rated. Atrophy of the caudate nuclei and ventricular enlargement were assessed through the bicaudate ratio (BCr) and the lateral ventricles to brain ratio (LVBr), respectively. Apolipoprotein E (APOE) genotypes were also assessed. The routine neurological examination was used to evaluate ISNAs that were clustered as central-based signs, cerebellar-based signs, and primitive reflexes. The items of Part-III of the Unified Parkinson’s Disease Rating Scale were used to evaluate ISNAs that were clustered as mild parkinsonian signs. Associations of ISNAs with imaging findings were determined through logistic regression analysis.Results:The ISNAs increase with the age and are present in all MCI types, particularly in those multiple domains, and carrying the APOE ϵ4 allele, and are associated with WMH, lacunes, BCr, and LVBr.Conclusion:This study demonstrates that cortical and subcortical vascular and atrophic processes contribute to ISNAs. Long prospective population-based studies are needed to disentangle the role of ISNAs in the conversion from MCI to dementia.

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Section: Participantsmentioning

confidence: 99%

Section: Baseline Clinical Assessmentmentioning

confidence: 99%

Section: Functional and Neuropsychological Assessmentsmentioning

confidence: 99%

Section: Carotid Ultrasonography and Imaging Assessmentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Isolated, Subtle Neurological Abnormalities in Mild Cognitive Impairment Types

Camarda

Pipia

et al. 2019

Can. J. Neurol. Sci.

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Brain Health After COVID-19, Pneumonia, Myocardial Infarction, or Critical Illness

Peinkhofer,

Zarifkar,

Christensen

et al. 2023

JAMA Netw Open

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ImportanceBrain health is most likely compromised after hospitalization for COVID-19; however, long-term prospective investigations with matched control cohorts and face-to-face assessments are lacking.ObjectiveTo assess whether long-term cognitive, psychiatric, or neurological complications among patients hospitalized for COVID-19 differ from those among patients hospitalized for other medical conditions of similar severity and from healthy controls.Design, Setting, and ParticipantsThis prospective cohort study with matched controls was conducted at 2 academic hospitals in Copenhagen, Denmark. The case cohort comprised patients with COVID-19 hospitalized between March 1, 2020, and March 31, 2021. Control cohorts consisted of patients hospitalized for pneumonia, myocardial infarction, or non–COVID-19 intensive care–requiring illness between March 1, 2020, and June 30, 2021, and healthy age- and sex-matched individuals. The follow-up period was 18 months; participants were evaluated between November 1, 2021, and February 28, 2023.ExposuresHospitalization for COVID-19.Main Outcomes and MeasuresThe primary outcome was overall cognition, assessed by the Screen for Cognitive Impairment in Psychiatry (SCIP) and the Montreal Cognitive Assessment (MoCA). Secondary outcomes were executive function, anxiety, depressive symptoms, and neurological deficits.ResultsThe study included 345 participants, including 120 patients with COVID-19 (mean [SD] age, 60.8 [14.4] years; 70 men [58.3%]), 125 hospitalized controls (mean [SD] age, 66.0 [12.0] years; 73 men [58.4%]), and 100 healthy controls (mean [SD] age, 62.9 [15.3] years; 46 men [46.0%]). Patients with COVID-19 had worse cognitive status than healthy controls (estimated mean SCIP score, 59.0 [95% CI, 56.9-61.2] vs 68.8 [95% CI, 66.2-71.5]; estimated mean MoCA score, 26.5 [95% CI, 26.0-27.0] vs 28.2 [95% CI, 27.8-28.6]), but not hospitalized controls (mean SCIP score, 61.6 [95% CI, 59.1-64.1]; mean MoCA score, 27.2 [95% CI, 26.8-27.7]). Patients with COVID-19 also performed worse than healthy controls during all other psychiatric and neurological assessments. However, except for executive dysfunction (Trail Making Test Part B; relative mean difference, 1.15 [95% CI, 1.01-1.31]), the brain health of patients with COVID-19 was not more impaired than among hospitalized control patients. These results remained consistent across various sensitivity analyses.Conclusions and RelevanceThis prospective cohort study suggests that post–COVID-19 brain health was impaired but, overall, no more than the brain health of patients from 3 non–COVID-19 cohorts of comparable disease severity. Long-term associations with brain health might not be specific to COVID-19 but associated with overall illness severity and hospitalization. This information is important for putting understandable concerns about brain health after COVID-19 into perspective.

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Nociceptive Primitive Reflexes in Neurologically and Cognitively Healthy Aging Subjects

Camarda

Torelli

Pipia

et al. 2019

Can. J. Neurol. Sci.

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ABSTRACT:Background: To assess the prevalence of three nociceptive primitive reflexes (nPR), i.e., glabellar tap, snout reflex, and palmomental reflex, in neurologically and cognitively healthy (NCH) aging subjects. Objective: To investigate whether nPR are cross-sectionally associated with white matter hyperintensities (WMH), lacunes, atrophy of the caudate nuclei, and global brain atrophy. Methods: A total of 1246 NCH subjects aged 45–91 years were included in the study and underwent standard brain MRI. Atrophy of the caudate nuclei and global brain atrophy were assessed through the bicaudate ratio (BCr) and lateral ventricles to brain ratio (LVBr), respectively. WMH were assessed through visual rating scales. Lacunes were also rated. Association of nPR with vascular risk factors/diseases and imaging findings was evaluated using logistic regression analysis. Results: nPR were exhibited by 33.1% of subjects and increased with age. Subjects with nPR performed less than subjects without nPR in tests evaluating global cognition, executive functions, attention, and language. Snout reflex was the most common nPR, followed by glabellar tap and palmomental reflex. Glabellar tap was associated with parieto-temporal WMH, BCr, and LVBr; snout reflex was associated with frontal lacunes, temporal WMH, BCr, and LVBr; palmomental reflex was associated with parieto-occipital WMH, basal ganglia lacunes, BCr, and LVBr. Conclusions: This study demonstrates that in NCH aging individuals, nPR are associated with WMH, lacunes, BCr, and LVBr and are probably a warning sign of incipient cognitive decline. Therefore, NCH subjects presenting nPR should manage their vascular risk factors/vascular diseases rigorously in order to prevent or delay progression of small vessel disease, and future neurological and cognitive disabilities.

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Isolated, subtle, neurological abnormalities in neurologically and cognitively healthy aging subjects

Cited by 11 publications

References 61 publications

Isolated, Subtle Neurological Abnormalities in Mild Cognitive Impairment Types

Isolated, Subtle Neurological Abnormalities in Mild Cognitive Impairment Types

Brain Health After COVID-19, Pneumonia, Myocardial Infarction, or Critical Illness

Nociceptive Primitive Reflexes in Neurologically and Cognitively Healthy Aging Subjects

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