Maria Paola Barbieri’s research while affiliated with University of Genoa and other places

To validate the Italian version of the Short Cognitive Evaluation Battery (SCEB), consisting of 4 tests (temporal orientation, five words, clock drawing and verbal fluency) in healthy controls (CONT), patients with mild Alzheimer's disease (AD), mild cognitive impairment (MCI), and major depressive disorder (DEP). Twenty-nine AD patients (mean Mini-Mental State Examination, MMSE, score: 22.1 ± 3.1), 27 MCI patients (mean MMSE score: 26.5 ± 2.0), 27 depressed patients (mean MMSE score: 26.9 ± 2.8), and 48 controls (mean MMSE score: 29.7 ± 0.5) were enrolled. MANCOVA showed highly significant (p < 0.0001) difference among groups. As for total SCEB score, AD were separated from CONT with high accuracy (93%; with sensitivity 93%, specificity 92%, area under ROC curve, AUC, 0.96) and from DEP with satisfying accuracy (84%; with sensitivity 76%, specificity 93%, AUC 0.84). Results in MCI versus CONT comparison yielded more moderate accuracy (80%; with sensitivity 70%, specificity 87%, AUC 0.80), which increased in the subgroup of MCI patients who later converted to AD (85%; with sensitivity 75%, specificity 83%, AUC 0.86). The direct comparison between MCI converters and nonconverters did not yield accurate results. The Italian version of the SCEB is a short (between 6 min in CONT and 12 min in DEP) screening tool in cognitive disorders of the elderly, and is potentially useful in clinical practice.

Antipsychotic drugs are widely used to treat behavioural and psychological disturbances associated with Alzheimer’s disease (AD), although only modest evidence from randomized controlled trials supports their efficacy, and increasing evidence from post-marketing surveillance shows serious adverse events associated with their use, including increased mortality. The AdCare study, a non-profit, randomized, placebo-controlled, double-blind, multicentre, pragmatic trial coordinated by the Italian National Institute of Health, aimed to evaluate the long-term safety and efficacy profiles of three atypical antipsychotic drugs (risperidone, olanzapine and quetiapine) and one conventional antipsychotic drug (haloperidol) in treating psychosis, aggression and agitation in outpatients with AD. The study was planned to be carried out in 19 clinical centres and to enrol 1000 outpatients. According to Italian law, in the case where a patient is considered unable to give informed consent, a legal representative designated by the court has to provide it. Because of difficulties in the informed consent procedure, the study had to be prematurely interrupted. From February 2009 to April 2010, 83 patients gave informed consent to participate in the trial. Fifty-six patients (68%) were included with consent given by a legal representative, while 27 patients (32%) were considered to provide personal informed consent on the basis of the results from a specifically built procedure. Patients and caregivers were offered the opportunity to participate in the trial before the occurrence of behavioural disturbances, in order to provide them with enough time to consider their participation in the study. Twenty-three patients experienced behavioural, clinically relevant symptoms and were randomized to the study drug; all randomized patients except one had consent for inclusion in the study given by legal representatives. After trial interruption, all patients taking an active drug continued treatment with the same molecule in clinical practice.

Our aim was to evaluate the factorial structure of the mini mental state examination (MMSE) in Alzheimer's disease (AD). Five hundred and twenty-four consecutive outpatients at their first diagnostic work-up (age 78.02+/-6.07 years, education 6.62+/-3.48 years, mean MMSE score 20.23+/-4.89) (+/-S.D.) with probable AD (based on DSM-IV and NINCDS-ADRDA criteria) were enrolled in a multicenter, cross-sectional, regional-based study. For the purpose of the present study, the 11 subtests composing the MMSE and the global MMSE score (ranging from 10 to 29, included) were considered. Factor analysis with Varimax rotation method identified two factors that explained about the 85% of total variance. The first factor explained the 65% of variance and mainly included temporal orientation, delayed recall, attention/concentration, and constructional praxia. The second factor explained the 20% of variance and included reading a sentence, writing a sentence, naming, verbal repetition and immediate memory. The first factor was a reliable index of cognitive deterioration along the MMSE score interval between 29 and 10, whereas the second factor was not a suitable marker in this range. The two-factor structure of the MMSE in AD is shown in a large series of patients. The first factor expresses the ability to use new information and is related with working memory. The second factor is related with a more consolidated knowledge, namely verbal abilities, and is essentially useless in mild to moderate AD.

Animaloid companion robots represent a very interesting paradigm. An increasing number of studies on this topic has been carried out in the past, involving such robots and older users affected by some kind of cognitive disease, from mild cognitive impairment (MCI) to more severe stages of Alzheimer's disease and other types of dementia. In the study described in this paper, an AIBO robotic dog was programmed and used to show simple reactive behaviors during the interaction with old adults. Experimental sessions were carried out with a group of 24 older subjects with cognitive deficits of relatively small entity (MMSE>23). Preliminary results seem to show the acceptability of this approach especially in subjects with a good relationship with technology. In the next future, the interaction between the robot and the old adults will be tested in more complex situations.