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Trojano, L.a  b , Gainotti, G.c  d 
Drawing Disorders in Alzheimer's Disease and Other Forms of Dementia
(2016) Journal of Alzheimer's Disease, 53 (1), art. no. JAD160009, pp. 31-52. 
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84976439986&partnerID=40&md5=f65537681d8ac1946bf40f5826294096

DOI: 10.3233/JAD-160009
AFFILIATIONS: aDepartment of Psychology, Second University of Naples, Viale Ellittico 31, Caserta, Italy; 
bS. Maugeri Foundation, Scientific Institute of Telese Terme (BN), Italy; 
cCenter for Neuropsychological Research, Institute of Neurology, Catholic University, Rome, Italy; 
IRCCS Fondazione Santa Lucia, Department of Clinical and Behavioral Neurology, Rome, Italy
ABSTRACT: Drawing is a multicomponential process that can be impaired by many kinds of brain lesions. Drawing disorders are very common in Alzheimer's disease and other forms of dementia, and can provide clinical information for the distinction of the different dementing diseases. In our review we started from an overview of the neural and cognitive bases of drawing, and from a recollection of the drawing tasks more frequently used for assessing individuals with dementia. Then, we analyzed drawing disorders in dementia, paying special attention to those observed in Alzheimer's disease, from the prodromal stages of the amnesic mild cognitive impairment to the stages of full-blown dementia, both in the sporadic forms with late onset in the entorhino-hippocampal structures and in those with early onset in the posterior neocortical structures. We reviewed the drawing features that could differentiate Alzheimer's disease from vascular dementia and from the most frequent forms of degenerative dementia, namely frontotemporal dementia and Lewy body disease. Finally, we examined some peculiar aspects of drawing disorders in dementia, such as perseverations, rotations, and closing-in. We argue that a careful analysis of drawing errors helps to differentiate the different forms of dementia more than overall accuracy in drawing.
AUTHOR KEYWORDS: Alzheimer's disease;  constructional apraxia;  drawing disorders;  frontotemporal dementia;  Lewy body disease;  vascular dementia
DOCUMENT TYPE: Review

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Lanzillo, B.a , Loreto, V.a , Calabrese, C.a , Estraneo, A.a , Moretta, P.a , Trojano, L.b

Does pain relief influence recovery of consciousness? A case report of a patient treated with ziconotide

(2016) European Journal of Physical and Rehabilitation Medicine, 52 (2), pp. 263-266. 
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84971408202&partnerID=40&md5=3e5b65d6c4d2d61ec2514a2b21c90914
AFFILIATIONS: a.Department of Neurorehabilitation, S. Maugeri IRCCS Foundation, Centro di Telese Terme Telese Terme, Via Bagni Vecchi 82037, Telese Terme (BN), Italy; 
b.Second University of Naples, Faculty of Psychology, Naples, Italy

ABSTRACT: For people with cervical spinal cord injury (SCI), access to computers can be difficult, thus several devices have been developed to facilitate their Disorders of consciousness (DOC) are difficult to classify. The degree of consciousness varies from coma to vegetative state or unresponsive wakefulness syndrome (UWS) and minimally conscious state. Correct diagnosis has important ethical and legal implications, and pain may be cause of misdiagnosis. We describe here a patient with traumatic brain injury, classified as UWS. His clinical picture was dominated by spasticity, and pain. He underwent intrathecal treatment of spasticity with baclofen. Improvement was not that expected. However, there was a dramatic improvement when ziconotide was added to relieve pain; the patient began to eat by mouth, talk, and his tracheal tube could be removed and he is currently classified as having severe disability. The suspension of ziconotide caused a clear re-worsening of clinical condition, reverted by his reintroduction. Pain is an important factor in patients with DOC. Anecdotal reports of improved consciousness with intrathecal baclofen therapy may be due to pain relief. Reduction of pain in DOC is important and drugs should not interfere with cognition, and must be effective and manageable. Ziconotide may be one of the possible candidate due to its synergistic antispastic action in combination with baclofen when an intratecal pump has been implanted. © 2015 EDIZIONI MINERVA MEDICA.
AUTHOR KEYWORDS: Baclofen;  Brain injuries;  Consciousness Disorders;  Pain;  Ziconotide; Injections, spinal
DOCUMENT TYPE: Article