Psychometrics and diagnostics of the Italian version of the Alternate Verbal Fluency Battery (AVFB) in non-demented Parkinson's disease patients.

Cognitive impairment Language; Executive Neuropsychology Parkinson’s disease Verbal fluency

Journal

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
ISSN: 1590-3478
Titre abrégé: Neurol Sci
Pays: Italy
ID NLM: 100959175

Informations de publication

Date de publication:
11 Mar 2024
Historique:
received: 22 05 2023
accepted: 29 02 2024
medline: 12 3 2024
pubmed: 12 3 2024
entrez: 12 3 2024
Statut: aheadofprint

Résumé

Verbal fluency (VF) tasks are known as suitable for detecting cognitive impairment (CI) in Parkinson's disease (PD). This study thus aimed to evaluate the psychometrics and diagnostics of the Alternate Verbal Fluency Battery (AVFB) by Costa et al. (2014) in an Italian cohort of non-demented PD patients, as well as to derive disease-specific cut-offs for it. N = 192 non-demented PD patients were screened with the Montreal Cognitive Assessment (MoCA) and underwent the AVFB-which includes phonemic, semantic and alternate VF tests (PVF; SVF; AVF), as well as a Composite Shifting Index (CSI) reflecting the "cost" of shifting from a single- to a double-cued VF task. Construct validity and diagnostics were assessed for each AVFB measure against the MoCA. Internal reliability and factorial validity were also tested. The MoCA proved to be strongly associated with PVF, SVF and AVF scores, whilst moderately with the CSI. The AVFB was internally consistent and underpinned by a single component; however, an improvement in both internal reliability and fit to its factorial structure was observed when dropping the CSI. Demographically adjusted scores on PVF, SVF and AVF tests were diagnostically sound in detecting MoCA-defined cognitive impairment, whilst this was not true for the CSI. Disease-specific cut-offs for PVF, SVF and AVF tests were derived. In conclusion, PVF, SVF and AVF tests are reliable, valid and diagnostically sound instruments to detect cognitive impairment in non-demented PD patients and are therefore recommended for use in clinical practice and research.

Sections du résumé

BACKGROUND BACKGROUND
Verbal fluency (VF) tasks are known as suitable for detecting cognitive impairment (CI) in Parkinson's disease (PD). This study thus aimed to evaluate the psychometrics and diagnostics of the Alternate Verbal Fluency Battery (AVFB) by Costa et al. (2014) in an Italian cohort of non-demented PD patients, as well as to derive disease-specific cut-offs for it.
METHODS METHODS
N = 192 non-demented PD patients were screened with the Montreal Cognitive Assessment (MoCA) and underwent the AVFB-which includes phonemic, semantic and alternate VF tests (PVF; SVF; AVF), as well as a Composite Shifting Index (CSI) reflecting the "cost" of shifting from a single- to a double-cued VF task. Construct validity and diagnostics were assessed for each AVFB measure against the MoCA. Internal reliability and factorial validity were also tested.
RESULTS RESULTS
The MoCA proved to be strongly associated with PVF, SVF and AVF scores, whilst moderately with the CSI. The AVFB was internally consistent and underpinned by a single component; however, an improvement in both internal reliability and fit to its factorial structure was observed when dropping the CSI. Demographically adjusted scores on PVF, SVF and AVF tests were diagnostically sound in detecting MoCA-defined cognitive impairment, whilst this was not true for the CSI. Disease-specific cut-offs for PVF, SVF and AVF tests were derived.
DISCUSSION CONCLUSIONS
In conclusion, PVF, SVF and AVF tests are reliable, valid and diagnostically sound instruments to detect cognitive impairment in non-demented PD patients and are therefore recommended for use in clinical practice and research.

Identifiants

pubmed: 38467953
doi: 10.1007/s10072-024-07436-5
pii: 10.1007/s10072-024-07436-5
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s).

Références

Baiano C, Barone P, Trojano L, Santangelo G (2020) Prevalence and clinical aspects of mild cognitive impairment in Parkinson’s disease: a meta-analysis. Mov Disord 35:45–54
pubmed: 31743500 doi: 10.1002/mds.27902
Rosenthal E, Brennan L, Xie S, Hurtig H, Milber J, Weintraub D et al (2010) Association between cognition and function in patients with Parkinson disease with and without dementia. Mov Disord 25:1170–1176
pubmed: 20310053 pmcid: 2963089 doi: 10.1002/mds.23073
Marras C, Rochon P, Lang AE (2002) Predicting motor decline and disability in Parkinson disease: a systematic review. Arch Neurol 59:1724–1728
pubmed: 12433259 doi: 10.1001/archneur.59.11.1724
Pedersen KF, Larsen JP, Tysnes OB, Alves G (2013) Prognosis of mild cognitive impairment in early Parkinson disease: the Norwegian ParkWest study. JAMA Neurol 70:580–586
pubmed: 23529397 doi: 10.1001/jamaneurol.2013.2110
Oosterveld LP, Allen JC Jr, Reinoso G, Seah SH, Tay KY, Au WL, Tan LC (2015) Prognostic factors for early mortality in Parkinson’s disease. Parkinsonism Relat Disord 21:226–230
pubmed: 25572499 doi: 10.1016/j.parkreldis.2014.12.011
Litvan I, Goldman JG, Tröster AI, Schmand BA, Weintraub D, Petersen RC et al (2012) Diagnostic criteria for mild cognitive impairment in Parkinson’s disease: movement Disorder Society Task Force guidelines. Mov Disord 27:349–356
pubmed: 22275317 pmcid: 3641655 doi: 10.1002/mds.24893
Henry JD, Crawford JR (2004) Verbal fluency deficits in Parkinson’s disease: a meta-analysis. J Int Neuropsychol Soc 10:608–622
pubmed: 15327739 doi: 10.1017/S1355617704104141
Koerts J, Meijer HA, Colman KS, Tucha L, Lange KW, Tucha O (2013) What is measured with verbal fluency tests in Parkinson’s disease patients at different stages of the disease? J Neural Transm 120:403–411
pubmed: 22922998 doi: 10.1007/s00702-012-0885-9
Pfeiffer HCV, Løkkegaard A, Zoetmulder M, Friberg L, Werdelin L (2014) Cognitive impairment in early-stage non-demented Parkinson’s disease patients. Acta Neurol Scand 129:307–318
pubmed: 24117192 doi: 10.1111/ane.12189
Torralva T, Laffaye T, Báez S, Gleichgerrcht E, Bruno D, Chade A et al (2015) Verbal fluency as a rapid screening test for cognitive impairment in early Parkinson’s disease. J Neuropsychiatry Clin Neurosci 27:244–247
pubmed: 26067437 doi: 10.1176/appi.neuropsych.14060139
Cholerton BA, Poston KL, Yang L, Rosenthal LS, Dawson TM, Pantelyat A et al (2021) Semantic fluency and processing speed are reduced in non-cognitively impaired participants with Parkinson’s disease. J Clin Exp Neuropsychol 43:469–480
pubmed: 34355669 pmcid: 8376799 doi: 10.1080/13803395.2021.1927995
Pereira JB, Junqué C, Martí MJ, Ramirez-Ruiz B, Bartres-Faz D, Tolosa E (2009) Structural brain correlates of verbal fluency in Parkinson’s disease. NeuroReport 20:741–744
pubmed: 19349926 doi: 10.1097/WNR.0b013e328329370b
Pagonabarraga J, Corcuera-Solano I, Vives-Gilabert Y, Llebaria G, García-Sánchez C, Pascual-Sedano B et al (2013) Pattern of regional cortical thinning associated with cognitive deterioration in Parkinson’s disease. PLoS ONE 8:e54980
pubmed: 23359616 pmcid: 3554657 doi: 10.1371/journal.pone.0054980
Ellfolk U, Joutsa J, Rinne JO, Parkkola R, Jokinen P, Karrasch M (2014) Striatal volume is related to phonemic verbal fluency but not to semantic or alternating verbal fluency in early Parkinson’s disease. J Neural Transm 121:33–40
pubmed: 23913130 doi: 10.1007/s00702-013-1073-2
Magdalinou NK, Golden HL, Nicholas JM, Witoonpanich P, Mummery CJ, Morris HR et al (2018) Verbal adynamia in parkinsonian syndromes: behavioral correlates and neuroanatomical substrate. Neurocase 24:204–212
pubmed: 30293517 pmcid: 6234546 doi: 10.1080/13554794.2018.1527368
Rodriguez-Porcel F, Wilmskoetter J, Cooper C, Taylor JA, Fridriksson J, Hickok G, Bonilha L (2021) The relationship between dorsal stream connections to the caudate and verbal fluency in Parkinson disease. Brain Imaging Behav 15:2121–2125
pubmed: 33044730 doi: 10.1007/s11682-020-00407-2
Yang J, McMahon KL, Copland DA, Pourzinal D, Byrne GJ, Angwin AJ et al (2022) Semantic fluency deficits and associated brain activity in Parkinson’s disease with mild cognitive impairment. Brain Imaging Behav 16:2445–2456
pubmed: 35841523 pmcid: 9712401 doi: 10.1007/s11682-022-00698-7
El-Nazer R, Adler CH, Beach TG, Belden CM, Artz J, Shill HA et al (2019) Regional neuropathology distribution and verbal fluency impairments in Parkinson’s disease. Parkinsonism Relat Disord 65:73–78
pubmed: 31109728 pmcid: 6774852 doi: 10.1016/j.parkreldis.2019.05.014
Camicioli R, Oken BS, Sexton G, Kaye JA, Nutt JG (1998) Verbal fluency task affects gait in Parkinson’s disease with motor freezing. J Geriatr Psychiatry Neurol 11:181–185
pubmed: 10230996 doi: 10.1177/089198879901100403
Amboni M, Cozzolino A, Longo K, Picillo M, Barone P (2008) Freezing of gait and executive functions in patients with Parkinson’s disease. Mov Disord 23:395–400
pubmed: 18067193 doi: 10.1002/mds.21850
Muslimović D, Post B, Speelman JD, Schmand B, de Haan RJ (2008) Determinants of disability and quality of life in mild to moderate Parkinson disease. Neurology 70:2241–2247
pubmed: 18519873 doi: 10.1212/01.wnl.0000313835.33830.80
Smulders K, van Nimwegen M, Munneke M, Bloem BR, Kessels RP, Esselink RA (2013) Involvement of specific executive functions in mobility in Parkinson’s disease. Parkinsonism Relat Disord 19:126–128
pubmed: 22771282 doi: 10.1016/j.parkreldis.2012.06.010
Højlund A, Petersen MV, Sridharan KS, Østergaard K (2017) Worsening of verbal fluency after deep brain stimulation in Parkinson’s disease: a focused review. Comput Struct Biotechnol J 15:68–74
pubmed: 27994799 doi: 10.1016/j.csbj.2016.11.003
Ferrucci R, Mameli F, Ruggiero F, Reitano M, Miccoli M, Gemignani A et al (2022) Alternate fluency in Parkinson’s disease: a machine learning analysis. PLoS ONE 17:e0265803
pubmed: 35320291 pmcid: 8942276 doi: 10.1371/journal.pone.0265803
Goldman JG, Holden S, Ouyang B, Bernard B, Goetz CG, Stebbins GT (2015) Diagnosing PD-MCI by MDS task force criteria: how many and which neuropsychological tests? Mov Disord 30:402–406
pubmed: 25449653 doi: 10.1002/mds.26084
Hoogland J, van Wanrooij LL, Boel JA, Goldman JG, Stebbins GT, Dalrymple-Alford JC et al (2018) Detecting mild cognitive deficits in Parkinson’s disease: comparison of neuropsychological tests. Mov Disord 33:1750–1759
pubmed: 30216541 pmcid: 6261669 doi: 10.1002/mds.110
Aiello EN, Rimoldi S, Bolognini N, Appollonio I, Arcara G (2022) Psychometrics and diagnostics of Italian cognitive screening tests: a systematic review. Neurol Sci 43:821–845
pubmed: 34816316 doi: 10.1007/s10072-021-05683-4
Ilardi CR, Menichelli A, Michelutti M, Cattaruzza T, Manganotti P (2023) Optimal MoCA cutoffs for detecting biologically-defined patients with MCI and early dementia. Neurol Sci 44:159–170
pubmed: 36169756 doi: 10.1007/s10072-022-06422-z
Salvadori E, Cova I, Mele F, Pomati S, Pantoni L (2022) Prediction of post-stroke cognitive impairment by Montreal Cognitive Assessment (MoCA) performances in acute stroke: comparison of three normative datasets. Aging Clin Exp Res 34:1855–1863
pubmed: 35441928 pmcid: 9283135 doi: 10.1007/s40520-022-02133-9
Aiello EN, Solca F, Torre S, Carelli L, Ferrucci R, Priori A et al (2022) Diagnostics and clinical usability of the Montreal Cognitive Assessment (MoCA) in amyotrophic lateral sclerosis. Front Psychol 13:1012632
pubmed: 36211901 pmcid: 9540377 doi: 10.3389/fpsyg.2022.1012632
Solca F, Aiello EN, Migliore S, Torre S, Carelli L, Ferrucci R et al (2022) Diagnostic properties of the Frontal Assessment Battery (FAB) in Huntington’s disease. Front Psychol 13:1031871
pubmed: 36533005 pmcid: 9748548 doi: 10.3389/fpsyg.2022.1031871
Aiello EN, Solca F, Torre S, Carelli L, Ferrucci R, Priori A et al (2023) Feasibility and diagnostics of the Frontal Assessment Battery (FAB) in amyotrophic lateral sclerosis. Neurol Sci 44:587–592
pubmed: 36201126 doi: 10.1007/s10072-022-06438-5
Aiello EN, Verde F, Milone I, Giacopuzzi Grigoli E, Dubini A, Carelli L et al (2022) The Frontal Assessment Battery (FAB) effectively discriminates between MCI and dementia within the clinical spectrum of neurochemically confirmed Alzheimer’s disease. Front Psychol 13:1054321
pubmed: 36533021 pmcid: 9748699 doi: 10.3389/fpsyg.2022.1054321
Aiello EN, Solca F, Torre S, Lafronza A, Maranzano A, Bonetti R et al (2023) Validity, diagnostics and feasibility of the Italian version of the Montreal Cognitive Assessment (MoCA) in Huntington’s disease. Neurol Sci 1–8
Aiello EN, D’Iorio A, Solca F, Torre S, Bonetti R, Scheveger F et al (2023) Clinimetrics and feasibility of the Italian version of the Frontal Assessment Battery (FAB) in non-demented Parkinson’s disease patients. J Neural Transm 130(5):687–696
pubmed: 36976351 doi: 10.1007/s00702-023-02624-7
D’Iorio A, Aiello EN, Amboni M, Vitale C, Verde F, Silani V et al (2023) Validity and diagnostics of the Italian version of the Montreal Cognitive Assessment (MoCA) in non-demented Parkinson’s disease patients. Aging Clin Exp Res 35:2157–2163
pubmed: 37480503 pmcid: 10519859 doi: 10.1007/s40520-023-02493-w
Terruzzi S, Funghi G, Meli C, Barozzi N, Zappini F, Papagno C, Dodich A (2023) The FACE test: a new neuropsychological task to assess the recognition of complex mental states from faces. Neurol Sci 1–9
Biundo R, Weis L, Pilleri M, Facchini S, Formento-Dojot P, Vallelunga A, Antonini A (2013) Diagnostic and screening power of neuropsychological testing in detecting mild cognitive impairment in Parkinson’s disease. J Neural Transm 120:627–633
pubmed: 23483334 doi: 10.1007/s00702-013-1004-2
Biundo R, Weis L, Facchini S, Formento-Dojot P, Vallelunga A, Pilleri M, Antonini A (2014) Cognitive profiling of Parkinson disease patients with mild cognitive impairment and dementia. Parkinsonism Relat Disord 20:394–399
pubmed: 24495708 doi: 10.1016/j.parkreldis.2014.01.009
Novelli G, Papagno C, Capitani E, Laiacona M, Cappa SF, Vallar G (1986) Tre test clinici di ricerca e produzione lessicale. Taratura su sogetti normali. Arch Psicol Neurol Psichiatr 47:278–296
Costa A, Bagoj E, Monaco M, Zabberoni S, De Rosa S, Papantonio AM et al (2014) Standardization and normative data obtained in the Italian population for a new verbal fluency instrument, the phonemic/semantic alternate fluency test. Neurol Sci 35:365–372
pubmed: 23963806 doi: 10.1007/s10072-013-1520-8
Downes JJ, Sharp HM, Costall BM, Sagar HJ, Howe J (1993) Alternating fluency in Parkinson’s disease: an evaluation of the attentional control theory of cognitive impairment. Brain 116:887–902
pubmed: 8353714 doi: 10.1093/brain/116.4.887
Kalbe E, Calabrese P, Kohn N, Hilker R, Riedel O, Wittchen HU et al (2008) Screening for cognitive deficits in Parkinson’s disease with the Parkinson neuropsychometric dementia assessment (PANDA) instrument. Parkinsonism Relat Disord 14:93–101
pubmed: 17707678 doi: 10.1016/j.parkreldis.2007.06.008
Pagonabarraga J, Kulisevsky J, Llebaria G, García-Sánchez C, Pascual-Sedano B, Gironell A (2008) Parkinson’s disease-cognitive rating scale: a new cognitive scale specific for Parkinson’s disease. Mov Disord 23:998–1005
pubmed: 18381647 doi: 10.1002/mds.22007
Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184
pubmed: 1564476 pmcid: 1014720 doi: 10.1136/jnnp.55.3.181
American Psychiatric Association (2013) Diagnostic and statistical manual of mentaldisorders (5th ed).
Carpinelli-Mazzi M, Iavarone A, Russo G, Musella C, Milan G, D’Anna F et al (2020) Mini-Mental State Examination: new normative values on subjects in Southern Italy. Aging Clin Exp Res 32:699–702
pubmed: 31230268 doi: 10.1007/s40520-019-01250-2
Aiello EN, Gramegna C, Esposito A, Gazzaniga V, Zago S, Difonzo T et al (2022) The Montreal Cognitive Assessment (MoCA): updated norms and psychometric insights into adaptive testing from healthy individuals in Northern Italy. Aging Clin Exp Res 34:375–382
pubmed: 34313961 doi: 10.1007/s40520-021-01943-7
Aiello EN, Pasotti F, Appollonio I, Bolognini N (2022) Equating Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores: conversion norms from a healthy Italian population sample. Aging Clin Exp Res 34:1721–1724
pubmed: 35182351 doi: 10.1007/s40520-022-02089-w
Skorvanek M, Goldman JG, Jahanshahi M, Marras C, Rektorova I, Schmand B et al (2018) Global scales for cognitive screening in Parkinson’s disease: critique and recommendations. Mov Disord 33:208–218
pubmed: 29168899 doi: 10.1002/mds.27233
Aita SL, Beach JD, Taylor SE, Borgogna NC, Harrell MN, Hill BD (2018) Executive, language, or both? An examination of the construct validity of verbal fluency measures. Appl Neuropsychol Adult 26:441–451
pubmed: 29513079 doi: 10.1080/23279095.2018.1439830
Aiello EN, Esposito A, Appollonio I, Bolognini N (2022) Diagnostic properties of the Frontal Assessment Battery (FAB) in Italian healthy adults. Aging Clin Exp Res 34:1021–1026
pubmed: 34981429 doi: 10.1007/s40520-021-02035-2
Kim HY (2013) Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis. Restor Dent Endod 38:52–54
pubmed: 23495371 pmcid: 3591587 doi: 10.5395/rde.2013.38.1.52
Cohen J (1988) Statistical power analysis for the behavioral sciences. New York, NY: Routledge Academic.
Capitani E, Laiacona M (2017) Outer and inner tolerance limits: their usefulness for the construction of norms and the standardization of neuropsychological tests. Clin Neuropsychol 31:1219–1230
pubmed: 28598726 doi: 10.1080/13854046.2017.1334830
Aiello EN, Depaoli EG (2022) Norms and standardizations in neuropsychology via equivalent scores: software solutions and practical guides. Neurol Sci 43:961–966
pubmed: 34142261 doi: 10.1007/s10072-021-05374-0
Larner AJ (2021) Measures not directly related to the 2 x 2 contingency table. In: Larner AJ (ed) The 2x2 matrix. contingency, confusion, and the metrics of binary classification. pp 113–132
Larner AJ (2021) Paired measures. In: Larner AJ (ed) The 2x2 matrix. contingency, confusion, and the metrics of binary classification. pp 15–48
Larner AJ (2019) New unitary metrics for dementia test accuracy studies. Prog Neurol Psychiatry 23:21–25
doi: 10.1002/pnp.543
Carelli L, Solca F, Migliore S, Torre S, Brugnera A, Mancini F et al (2021) Compensating for verbal-motor deficits in neuropsychological assessment in movement disorders: sensitivity and specificity of the ECAS in Parkinson’s and Huntington’s diseases. Neurol Sci 42:4997–5006
pubmed: 33728549 doi: 10.1007/s10072-021-05169-3
Abrahams S, Leigh PN, Harvey A, Vythelingum GN, Grise D, Goldstein LH (2000) Verbal fluency and executive dysfunction in amyotrophic lateral sclerosis (ALS). Neuropsychologia 38:734–747
pubmed: 10689049 doi: 10.1016/S0028-3932(99)00146-3
Canu E, Castelnovo V, Rancoita PM, Leocadi M, Lamanuzzi A, Spinelli EG, Agosta, F (2023) Italian reference values and brain correlates of verbal fluency index–vs standard verbal fluency test–to assess executive dysfunction in ALS. Amyotrophic LateralSclerosis and Frontotemporal Degeneration. 1–9
Jacobs DM, Marder K, Cote LJ, Sano M, Stern Y, Mayeux R (1995) Neuropsychological characteristics of preclinical dementia in Parkinson’s disease. Neurology 45:1691–1696
pubmed: 7675228 doi: 10.1212/WNL.45.9.1691
Zanin E, Aiello EN, Diana L, Fusi G, Bonato M, Niang A et al (2022) Tele-neuropsychological assessment tools in Italy: a systematic review on psychometric properties and usability. Neurol Sci 43:125–138
pubmed: 34751849 doi: 10.1007/s10072-021-05719-9
Aiello EN, Preti AN, Pucci V, Diana L, Corvaglia A, di San Pietro CB, N. et al (2022) The Italian telephone-based Verbal Fluency Battery (t-VFB): standardization and preliminary clinical usability evidence. Front Psychol 13:963164
pubmed: 35992426 pmcid: 9384842 doi: 10.3389/fpsyg.2022.963164

Auteurs

Edoardo Nicolò Aiello (EN)

Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.

Francesca Mameli (F)

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Fabiana Ruggiero (F)

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Eleonora Zirone (E)

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Stefano Zago (S)

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Sylvie Piacentini (S)

Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.

Barbara Poletti (B)

Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.
Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Via Santa Sofia 9, 20122, Milan, Italy.

Maria Rita Reitano (MR)

ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy.

Gabriella Santangelo (G)

Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.

Nicola Ticozzi (N)

Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.
Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy.

Vincenzo Silani (V)

Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.
Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy.

Alberto Priori (A)

ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy.
"Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy.

Roberta Ferrucci (R)

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. roberta.ferrucci@unimi.it.
Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Via Santa Sofia 9, 20122, Milan, Italy. roberta.ferrucci@unimi.it.

Classifications MeSH