Giancarlo Logroscino MD PhD

Neurodegenerative Diseases Unit

Department of Basic Medicine

Neuroscience and Sense Organs

Department of Clinical Research in

Neurology of the University of Bari at

“Pia Fondazione Card G. Panico“

Hospital Tricase (Le)

University Aldo Moro Bari Italy

APA: Linee Guida per

la Pratica Psicologica:

Il punto di vista del

neurologo

1. la demografia ha cambiato il paziente con AD

The AD Diagnosis is Late

2.necessità di anticipare la diagnosi

I CRITERI NIA (NATIONAL INSTITUTE ON AGING)

FASE PRECLINICA

MCI due to AD

DEMENTIA due to AD

2007

2010

2014

Standardized NP assessment

Processing

Speed

Sustained

Learning

Recall

Recognition

Naming

Comprehension

Production

Cognitive

Flexibility

Cognitive

Inhibition

Focused

Working

memory

Praxis Gnosis

Planning

ATTENTION

LANGUAGE

MEMORY

EXECUTIVE

FUNCTIONS

VISUOSPATIAL

ABILITIES

COGNITIVE FUNCTIONING

Neuropsychology in diagnosis: Timing

Nature Neur., (6), 2010

• memory tests change relatively early in the disease course (1) and soon reach a plateau at high levels of impairment (2)

• They are useful for diagnosis at the MCI stage, but are less useful for tracking later disease progression (3).

• Verbal comprehension tests start to change later in the disease course: during MCI they show mild or no impairment (4), and are of limited use in diagnosis.

• These markers become more sensitive at the dementia stage, when the slope of change steepens (5)

NEUROCOGNITIVE

DOMAINS

Social cognition Recognition of emotions,

teory of mind

Perception Visual perception, visuoconstructional,

perceptual-motor, praxis and gnosis

Learning and Memory Immediate and recent memory; long term memory

Executive function Planning, decision making, working memory, mental flexibility, cognitive inhibition

Complex attention Sustained, divided, selective and processing speed

MILD NEUROCOGNITIVE

DISORDER

NEUROPSICOLOGY

CLINICAL RESEARCH

Assessment

Multidisciplinary team:

Neurologist, Imaging,

Laboratory

Intervention

- Psychological interventions: patient/caregiver

- Cognitive rehabilitation

Diagnosis Cognitive profile

Limite nel confronto: differenze sostanziali nel sistema

della salute

Medici di Medicina Generale

(Primary Care)

e demenze

•Diagnosi precoce

•Buon trattamento

NEUROPSICOLOGY

CLINICAL RESEARCH

Cognitive screening

to detect global

impairment

1. Comprehensive assessment to

identify cognitive phenotype

2. Behavioral evaluation: apathy,

depressive symptoms etc.

SETTING

Clinical center

MMG

Population based

ASSESSMENT

APA document: Training Inadeguato

• 58% non si sentivano preparati a lavoro

clinico con i 65+

• 70 ritenevano di dover riqualificarsi con un

formale di gerontopsicologia per lavorare

con i 65+

MdF: Io uso prove specifiche e / o

protocolli per aiutarmi a diagnosticare

e gestire la demenza

Somministro test cognitivi di screening quando sospetto

la presenza di un disturbo della memoria o di altro

disturbo cognitivo

Ho inviato negli ultimi tre mesi all’UVA pazienti

in fase iniziale di decadimento cognitivo

APA document:

Challenges of Clinical Work among Older Adults

• cohort (generational)

• perspectives and beliefs (e.g., family obligations,

perceptions of mental disorders),

• comorbid physical illnesses,

• the potential for and effects of polypharmacy,

• cognitive or sensory impairments

• history of medical or mental/ neurological

disorders

APA DOC/ Psy e Neurologo: Conclusioni

• Cambi di Prospettiva nella Pratica Clinica

• Setting di Lavoro

• Mancanza di Training specifico

• Differenze enormi tra i Due Sistemi

Sanitari