Papers by Massimiliano Ruggeri
Journal of the Neurological Sciences, Oct 1, 2021
International Journal of Language & Communication Disorders, Jul 29, 2020
Background: Despite initial underreporting of language dysfunctions in corticobasal syndrome (CBS... more Background: Despite initial underreporting of language dysfunctions in corticobasal syndrome (CBS), aphasia is now recognized as a frequent feature of this disease. Aphasia in CBS seems clinically overlying to a nonfluent/agrammatic primary progressive aphasia (nfaPPA), which is also a clinical phenotype associated with corticobasal degeneration (CBD) pathology. However, the clinical features of aphasia in CBS still remain poorly delineated, resulting in misjudgements in the differential diagnosis from a PPA presentation of the disease. Aims: To investigate the language disorders of this syndrome, also through a systematic examination of recoding skills (reading, written spelling and repetition) and articulatory disturbances, which have been rarely examined in previous studies. Methods & Procedures: We present a clinical and neuropsychological descriptive study of the language impairments in a case series of 12 aphasic patients with a clinical diagnosis of CBS. Language assessment was conducted by means of the Esame NeuroPsicologico dell'Afasia, a comprehensive Italian battery for language functions, the Token Test, and the Apraxia of Speech Rating Scale. Outcomes & Results: The language profile of the patients showed a severe expressive language disorder, characterized by non-fluent speech, apraxia of speech (AoS) with predominant stuttering-like dysfluencies, spatial/apraxic agraphia, lack of word-finding and defective sentence repetition. Severe limb apraxia, visual-spatial deficit and alien hand syndrome were also present. Neuroimaging showed bilateral left asymmetric atrophies and hypometabolism in the frontal premotor, parietal posterior and temporal areas. Conclusions & Implications: These findings suggest that aphasia in CBS might present as a 'mixed PPA', instead of an nfaPPA as previously stated, showing a combination of features of the nfa and logopenic variants of the PPA, associated with AoS, stuttering and agraphia, which might be additional important cognitive markers for the clinical diagnosis of CBS and discriminating features of an nfaPPA presentation of a CBD. These results might also suggest specific intervention areas in the rehabilitation of patients with CBS.
Archives of Gerontology and Geriatrics, Jul 1, 2020
Background: The purpose of this study was to explore the clinical and brain functional abnormalit... more Background: The purpose of this study was to explore the clinical and brain functional abnormalities in patients with mild Alzheimer's Disease (AD) and patients with amnesic Mild Cognitive Impairment (aMCI). Methods: we used resting spect-neuropsychology correlations method. Results: We found that parieto-temporal associative cortex, mainly involving the inferior parietal lobule, posterior cingulate and middle temporal gyrus, is compromised early in AD. These results suggest that the dysfunction in these areas contributes to cognitive decline in the storage of verbal information, drawing abilities and non-verbal abstract reasoning in AD. The aMCI group showed hypoperfusion primarily involving the frontal areas bilaterally, and this correlated with the impairment in free delayed recall on a verbal memory task. Conclusion: Our results underlie the clinical differences between AD and aMCI patients that might reflect the involvement of different degenerative mechanisms in these groups.
European Archives of Psychiatry and Clinical Neuroscience
Cortex, May 1, 2021
Craniopharyngiomas (CP's) are hypothalamic tumors often associated with psychological disorde... more Craniopharyngiomas (CP's) are hypothalamic tumors often associated with psychological disorders. Nevertheless, its diagnosis is still challenging when psychiatric disorders are not associated with any other neurological symptoms. This single-case study describes a patient with a history of bipolar disorder before a diagnosis of a large CP arising the sellar and suprasellar region was posed. At the time of the present study the patient showed emotional/behavioral disorders and Korsakoff-like amnesia, that completely recovered after surgical resection of the tumor. This is one of those few cases described in literature, who presented cognitive/behavioral disorders because the compression of the diencephalic structures due to CP mass effect. This case offers further evidence on the functional neuroanatomy of the hypothalamus and its pathways.
Cortex, May 1, 2021
Craniopharyngiomas (CP's) are hypothalamic tumors often associated with psychological disorde... more Craniopharyngiomas (CP's) are hypothalamic tumors often associated with psychological disorders. Nevertheless, its diagnosis is still challenging when psychiatric disorders are not associated with any other neurological symptoms. This single-case study describes a patient with a history of bipolar disorder before a diagnosis of a large CP arising the sellar and suprasellar region was posed. At the time of the present study the patient showed emotional/behavioral disorders and Korsakoff-like amnesia, that completely recovered after surgical resection of the tumor. This is one of those few cases described in literature, who presented cognitive/behavioral disorders because the compression of the diencephalic structures due to CP mass effect. This case offers further evidence on the functional neuroanatomy of the hypothalamus and its pathways.
Journal of the Neurological Sciences, 2021
Results We found, during lockdown, a significant decrease in total ED attendances (4664) when com... more Results We found, during lockdown, a significant decrease in total ED attendances (4664) when compared to the matched control (10424) and to the pre-lockdown (9522) periods. Similarly, a reduction was detected for seizure attendances: 37 during lockdown and 63 and 44 respectively during the two other time periods. Interesting we found that more patients attended the ED with first seizures (p = 0.013), and a higher number of EEGs (p = 0.008) and CT brain scans (p = 0.018) were performed during lockdown; a trend favouring a more frequent transport to the ED by ambulance (p = 0.061) was also noted during lockdown period. Conclusions The pandemic had a relevant impact on how patients with seizures accessed the ED.
International Journal of Neurology and Neurotherapy, 2016
Heat stroke is the result of high heat stress and determines multiorgan dysfunction with predomin... more Heat stroke is the result of high heat stress and determines multiorgan dysfunction with predominant encephalopathy. Heat stroke only rarely leads to permanent neurologic deficits with a propensity to cerebellar dysfunction while memory disorders are very unusual. We report a unique case of a patient who suffered from a heat stroke after strenuous physical activity and sauna, resulting in persistent memory deficit with normal acute and follow-up normal MRI. Neuropsychological assessment suggested an involvement of the hippocampal-depending memory process. This is the only case in literature with long-lasting memory deficit with no MRI abnormalities, following heat stroke after excessive exercise and sauna.
Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology, 2016
Damage to the dorsomedial thalamus usually leads to impaired episodic memory, attention, and exec... more Damage to the dorsomedial thalamus usually leads to impaired episodic memory, attention, and executive function, but the role of the dorsomedial thalamus in memory processing is still not fully understood. Clinical evidence is inconclusive about whether dorsomedial thalamic damage impairs recall or whether it impairs recognition. I report a unique patient who suffered a cardioembolic stroke in the paramedian artery territory, caused by a patent foramen ovale. He was left with a chronic ischemic lesion centered in the parvocellular and, to a lesser extent, the magnocellular portions of the left dorsomedial thalamic nucleus, and marginally involving the midline and intralaminar nuclei. A year after the stroke, the patient's neuropsychological assessment showed a selective verbal memory deficit with greater loss of recall than recognition. His memory was normal when he was given semantically encoded material. His test results showed that damage to the left dorsomedial thalamic nucl...
Archives of Clinical Neuropsychology
Objective The Rey Auditory Verbal Learning Test (RAVLT) is a widely used verbal memory measure th... more Objective The Rey Auditory Verbal Learning Test (RAVLT) is a widely used verbal memory measure that provides scores for different aspects of memory. It involves repeated auditory presentation and recall of a 15-item word list (List A) followed by presentation and recall of a distractor list (List B) and then un-cued immediate and delayed recalls (at 15 min and 1 week) of List A as well as recognition testing. Aims of this study are to provide Italian normative data for certain RAVLT Scores and Composite Indices to improve the diagnostic accuracy of the test in clinical settings and to provide further evidence on how RAVLT can differentiate different amnesia profiles due to focal lesions. Methods We enrolled 440 healthy participants and RAVLT Single Scores and Composite Indices have been analyzed by means of multiple regression to verify the influence of age, education, and gender. Results We computed the best linear models with RAVLT Single Scores and Composite Indices, as dependent...
Cortex, 2021
Craniopharyngiomas (CP's) are hypothalamic tumors often associated with psychological disorde... more Craniopharyngiomas (CP's) are hypothalamic tumors often associated with psychological disorders. Nevertheless, its diagnosis is still challenging when psychiatric disorders are not associated with any other neurological symptoms. This single-case study describes a patient with a history of bipolar disorder before a diagnosis of a large CP arising the sellar and suprasellar region was posed. At the time of the present study the patient showed emotional/behavioral disorders and Korsakoff-like amnesia, that completely recovered after surgical resection of the tumor. This is one of those few cases described in literature, who presented cognitive/behavioral disorders because the compression of the diencephalic structures due to CP mass effect. This case offers further evidence on the functional neuroanatomy of the hypothalamus and its pathways.
International Journal of Language & Communication Disorders, 2020
BACKGROUND Despite initial underreporting of language dysfunctions in corticobasal syndrome (CBS)... more BACKGROUND Despite initial underreporting of language dysfunctions in corticobasal syndrome (CBS), aphasia is now recognized as a frequent feature of this disease. Aphasia in CBS seems clinically overlying to a non-fluent/agrammatic primary progressive aphasia (nfaPPA), which is also a clinical phenotype associated with corticobasal degeneration (CBD) pathology. However, the clinical features of aphasia in CBS still remain poorly delineated, resulting in misjudgements in the differential diagnosis from a PPA presentation of the disease. AIMS To investigate the language disorders of this syndrome, also through a systematic examination of recoding skills (reading, written spelling and repetition) and articulatory disturbances, which have been rarely examined in previous studies. METHODS & PROCEDURES We present a clinical and neuropsychological descriptive study of the language impairments in a case series of 12 aphasic patients with a clinical diagnosis of CBS. Language assessment was conducted by means of the Esame NeuroPsicologico dell'Afasia, a comprehensive Italian battery for language functions, the Token Test, and the Apraxia of Speech Rating Scale. OUTCOMES & RESULTS The language profile of the patients showed a severe expressive language disorder, characterized by non-fluent speech, apraxia of speech (AoS) with predominant stuttering-like dysfluencies, spatial/apraxic agraphia, lack of word-finding and defective sentence repetition. Severe limb apraxia, visual-spatial deficit and alien hand syndrome were also present. Neuroimaging showed bilateral left asymmetric atrophies and hypometabolism in the frontal premotor, parietal posterior and temporal areas. CONCLUSIONS & IMPLICATIONS These findings suggest that aphasia in CBS might present as a 'mixed PPA', instead of an nfaPPA as previously stated, showing a combination of features of the nfa and logopenic variants of the PPA, associated with AoS, stuttering and agraphia, which might be additional important cognitive markers for the clinical diagnosis of CBS and discriminating features of an nfaPPA presentation of a CBD. These results might also suggest specific intervention areas in the rehabilitation of patients with CBS. What this paper adds What is already known on the subject Language disorders in CBS patients usually present clinically overlying to an nfaPPA, which is also a clinical phenotype associated with CBD pathology, according to recent diagnostic criteria. However, the clinical features of aphasia in CBS still remain poorly delineated, and this raises difficulties and misjudgements for clinicians in the differential diagnosis from a PPA presentation of the disease. What this paper adds to existing knowledge This study shows that the language profile of our CBS patients was characterized by severe expressive language disorders, with non-fluent speech, apraxia of speech (AoS) with predominant stuttering-like dysfluencies, spatial/apraxic agraphia, lack of word-finding, and defective sentence repetition. These findings suggest that aphasia in CBS might present as a 'mixed PPA', rather than an nfaPPA as previously stated, showing a combination of features of the nfa and logopenic variants of the PPA associated with AoS, stuttering and agraphia. What are the potential or actual clinical implications of this work? These results suggest that AoS, stuttering and agraphia might be important additional cognitive markers for the clinical diagnosis of CBS, and discriminating features of an nfaPPA presentation of a CBD. The language disorders exhibited in the present study might also support speech and language therapists in targeting specific intervention areas in the rehabilitation of patients with CBS.
Revue Neurologique, 2019
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Archives of Gerontology and Geriatrics, 2020
BACKGROUND The purpose of this study was to explore the clinical and brain functional abnormaliti... more BACKGROUND The purpose of this study was to explore the clinical and brain functional abnormalities in patients with mild Alzheimer's Disease (AD) and patients with amnesic Mild Cognitive Impairment (aMCI). METHODS we used resting spect-neuropsychology correlations method. RESULTS We found that parieto-temporal associative cortex, mainly involving the inferior parietal lobule, posterior cingulate and middle temporal gyrus, is compromised early in AD. These results suggest that the dysfunction in these areas contributes to cognitive decline in the storage of verbal information, drawing abilities and non-verbal abstract reasoning in AD. The aMCI group showed hypoperfusion primarily involving the frontal areas bilaterally, and this correlated with the impairment in free delayed recall on a verbal memory task. CONCLUSION Our results underlie the clinical differences between AD and aMCI patients that might reflect the involvement of different degenerative mechanisms in these groups.
The PQRST strategy is a specific treatment procedure for story recall disorders; it is divided in... more The PQRST strategy is a specific treatment procedure for story recall disorders; it is divided into 5 phases (Preview, Question, Read, State, Test), and was first suggested by Glasgow e al. (1977), and later by Wilson (1987). Although the PQRST strategy is often mentioned as an effective cognitive strategy for the rehabilitation of memory, little has been published on its effectiveness, and results from previous studies showed some limits in the applicability of the procedure. This research investigated the effectiveness of PQRST strategy in the rehabilitation of story recall disorders; a major effort was done in order to bypass a few of the limits that were reported in previous studies, and namely, memory and executive functions in story recalling were assessed, and selective improvement in story recalling exclusively was controlled for as well. A group of ten amnesic patients, aged 24 to 72, who suffered from mild to serious memory problems and presented with different neurologica...
Cognitive Neuropsychiatry
Journal of the Neurological Sciences
Journal of the Neurological Sciences
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Papers by Massimiliano Ruggeri