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Brain electrical activity (quantitative EEG and bit-mapping neurocognitive CNV components), psychometrics and clinical findings in presenile subjects with initial mild cognitive decline or probable Alzheimer-type dementia

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Abstract

Clinical, neuropsychological and neuropsychophysiological data (Q-EEG, ERPs and CNV/RT activity) were obtained from 24 patients who had more or less severe presenile primary cognitive decline without depression, and compared with similar data from 10 age-matched healthy volunteers (mean age, 59.4 years). All of the patients (15 M and 9 F; mean age 59.6 years) were selected according to the DSM III-R, ICD-10 and NINCDS-ADRDA criteria and underwent CT and MRI scanning, in addition to a standard clinical examination, a battery of psychometric tests, spectral EEG, and bit-mapped CNV complex and RT to S2 analyses. Twelve of the 24 patients presented an initial presenile idiopathic cognitive decline (PICD) but did not wholly fulfil the clinical and neuropsychological criteria for primary dementia or for a diagnosis of probable AD; the remaining 12 patients showed characteristic clinical signs and symptoms of a very probable early stage of presenile Alzheimer-type dementia (PAD). ANOVA, correlational and discriminant analyses of the neuropsychological test scores, and the neurophysiological and RT to S2 data revealed 22 highest-ranked between-group discriminant factors (all with a significance level of p<0.01). The conclusive discriminant analysis retained 13 of these factors as final canonical functions, and these showed a 97% grouping accuracy (33 of the 34 subjects examined); the same percentage of correct classifications was also achieved using only the 15 best indicators in the group of CNV/RT findings. Using both of these sets of highest-ranked discriminators, all of the normal subjects and all of the PAD patients were correctly classified; only 1 PICD patient was misclassified as normal when the first group of 13 factors was used, and another PICD patient was misclassified as PAD using the second group of 15 factors. Our findings suggest that, providing they are correctly performed and interpreted, these non-invasive techniques may be an important tool for identifying incipient stages of presenile Alzheimer-type dementia.

Sommario

Sono stati esaminati da un punto di vista clinico, neuropsicologico e neuro-psicofisiologico (Q-EEG, potenziali neurocognitivi del complesso CNV e tempo di reazione, TR, a segnali incondizionati) in 24 pazienti con forme più o meno gravi di deterioramento cognitivo presenile idiopatico (15 maschi e 9 femmine; età media 59.6) ed i dati sono stati confrontati con quelli raccolti in 10 soggetti sani di controllo di pari età (media 59.4).

In 12 pazienti era stata formulata una diagnosi di sospetta/possibile forma iniziale presenile di demenza primaria (PICD), poiché i loro sintomi non completavano del tutto i criteri clinici del DSM III-R, dell'ICD-10 e del NINCDS-ADRDA Report proposti per le varie forme di demenza. Dodici pazienti presentavano un classico quadro clinico di iniziale demenza presenile di tipo Alzheimer (PAD). Tutti i pazienti sono stati sottoposti preliminarmente ad esami clinici, TAC, RMN, EEG con analisi spettrale e ad una batteria di test psicodiagnostici. Una valutazione statistica mediante analisi della varianza, test di correlazione ed analisi discriminante di tutti i dati neuropsicologici, neurofisiologici oltre che dei TR agli stimoli incondizionati (S2), hanno selezionato 22 singoli fattori discriminanti fra i 3 gruppi di soggetti ad un livello di significatività di p<0.01. Ad un'analisi discriminante conclusiva 13 di questi 22 fattori hanno consentito una precisa identificazione nel 97% dei casi (33 dei 34 soggetti esaminati), e la stessa percentuale di corretta classificazione è stata ottenuta anche utilizzando i fattori discriminanti relativi ai soli dati del complesso CNV e dei TR ed S2. Con entrambi i gruppi di fattori tutti i soggetti normali ed i pazienti affetti da PAD sono stati esattamente identificati; solo 1 PICD risultò erroneamente classificato come normale con il primo gruppo di fattori discriminanti, ed un altro come PAD con il secondo gruppo di fattori. Questi risultati confermano la notevole utilità di tali metodiche non-invasive nella diagnosi precoce delle demenze primarie presenili, se correttamente eseguite ed interpretate come già dimostrato in nostre precedenti ricerche.

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Authors and Affiliations

  1. Servizio di Neuroradiologia, Fondazione C. Mondino IRCCS, Università di Pavia, (Italy)

    Zappoli F.

  2. Direzione Medica, Market Company Italia, Pharmacia, Milano, (Italy)

    Battaglia A.

  3. Dipartimento di Scienze Neurologiche e Psichiatriche, Seconda Clinica Neurologica, Università di Firenze, V.le Morgagni 85, 50134, Firenze, Italy

    Zappoli R., Versari A., Paganini M., Arnetoli G., Muscas G. C., Gangemi P. F., Arneodo M. G. & Poggiolini D.

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  1. Zappoli R.
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This investigation was supported by National Research Council Grants (Aging Program Project: CNR No. 02854.04; 00394. PF40; 00467. PF40; Code No 954569).

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Zappoli, R., Versari, A., Paganini, M. et al. Brain electrical activity (quantitative EEG and bit-mapping neurocognitive CNV components), psychometrics and clinical findings in presenile subjects with initial mild cognitive decline or probable Alzheimer-type dementia. Ital J Neuro Sci 16, 341–376 (1995). https://doi.org/10.1007/BF02229172

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