Luigi Trojano

Professor of Neuropsychology

Name Luigi
Surname Trojano
Institution Università degli Studi della Campania Luigi Vanvitelli
Address Department of Psychology, University of Campania 'Luigi Vanvitelli', Viale Ellittico 31, 81100 Caserta, Italy


  • Comparison of alternate and original forms of the Montreal Cognitive Assessment (MoCA): an Italian normative study.

    Publication Date: 14/01/2019 on Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
    by Siciliano M, Chiorri C, Passaniti C, Sant'Elia V, Trojano L, Santangelo G
    DOI: 10.1007/s10072-019-3700-7

    The Montreal Cognitive Assessment (MoCA) is a screening test widely used in clinical practice and suited for detection of Mild Cognitive Impairment. Alternate forms of the MoCA were developed to avoid "learning effect" in serial assessments, and the present study aimed at investigating inter-form parallelism and at providing normative values for the Italian versions of MoCAs 2 and 3.

  • Regression-based normative data and equivalent scores for Trail Making Test (TMT): an updated Italian normative study.

    Publication Date: 07/12/2018 on Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
    by Siciliano M, Chiorri C, Battini V, Sant'Elia V, Altieri M, Trojano L, Santangelo G
    DOI: 10.1007/s10072-018-3673-y

    The Trail Making Test (TMT) is widely used to assess psychomotor speed and attentional set-shifting. Since the regression-based norms and equivalent scores (ESs) for the TMT Italian version trace back to more than 20 years ago, we aimed at providing updated normative data for basic (Part A and Part B) and derived (Score B-A and Score B/A) TMT scores collected in a larger sample with an extended age range.

  • Selegiline in Patients With Disorder of Consciousness: An Open Pilot Study.

    Publication Date: 01/11/2018 on The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques
    by Masotta O, Trojano L, Loreto V, Moretta P, Estraneo A
    DOI: 10.1017/cjn.2018.315

    This open study investigated the clinical effects of 10-week selegiline administration in six patients in vegetative state and in four patients in a minimally conscious state, at least 6 months after onset. Clinical outcome was assessed by Coma Recovery Scale-Revised once a week during selegiline administration and 1 month later. Three patients stopped treatment because of possible side effects. After treatment and at 1 month of follow-up, four patients showed improvements in clinical diagnosis, and three patients showed an increase in arousal level only. Selegiline might represent a relatively safe option to enhance arousal and promote recovery in brain-injured patients with disorders of consciousness.

  • "Pure apathy" and cognitive dysfunctions in Parkinson's disease: A meta-analytic study.

    Publication Date: 01/11/2018 on Neuroscience and biobehavioral reviews
    by D'Iorio A, Maggi G, Vitale C, Trojano L, Santangelo G
    DOI: 10.1016/j.neubiorev.2018.08.004

    Parkinson's Disease (PD) is characterized by motor and non-motor symptoms such as cognitive deficit and behavioural disturbances. Apathy seems to be related to cognitive impairment, but some studies failed to confirm the relationship due to different methodological procedures across studies. A meta-analysis on 8 studies was performed to explore the cognitive correlates of apathy without depression and dementia (pure apathy). Global cognitive function, memory, executive functions, processing speed/attention/working memory, visuospatial abilities and language were the outcomes. The effect size of the relationship between "pure apathy" and reduced global cognitive functioning, executive functions, processing speed/attention/working memory, visuospatial functions, long-term verbal memory was moderate, whereas apathy was strongly associated with inhibition dysfunctioning. Our results revealed a strong association between "pure apathy" and cognitive dysfunctions, particularly deficit of memory and executive functions related to altered prefronto-subcortical circuitries.

  • Multimodal Neuroimaging Approach to Variability of Functional Connectivity in Disorders of Consciousness: A PET/MRI Pilot Study.

    Publication Date: 18/10/2018 on Frontiers in neurology
    by Cavaliere C, Kandeepan S, Aiello M, Ribeiro de Paula D, Marchitelli R, Fiorenza S, Orsini M, Trojano L, Masotta O, St Lawrence K, Loreto V, Chronik BA, Nicolai E, Soddu A, Estraneo A
    DOI: 10.3389/fneur.2018.00861

    Behavioral assessments could not suffice to provide accurate diagnostic information in individuals with disorders of consciousness (DoC). Multimodal neuroimaging markers have been developed to support clinical assessments of these patients. Here we present findings obtained by hybrid fludeoxyglucose (FDG-)PET/MR imaging in three severely brain-injured patients, one in an unresponsive wakefulness syndrome (UWS), one in a minimally conscious state (MCS), and one patient emerged from MCS (EMCS). Repeated behavioral assessment by means of Coma Recovery Scale-Revised and neurophysiological evaluation were performed in the two weeks before and after neuroimaging acquisition, to ascertain that clinical diagnosis was stable. The three patients underwent one imaging session, during which two resting-state fMRI (rs-fMRI) blocks were run with a temporal gap of about 30 min. rs-fMRI data were analyzed with a graph theory approach applied to nine independent networks. We also analyzed the benefits of concatenating the two acquisitions for each patient or to select for each network the graph strength map with a higher ratio of fitness. Finally, as for clinical assessment, we considered the best functional connectivity pattern for each network and correlated graph strength maps to FDG uptake. Functional connectivity analysis showed several differences between the two rs-fMRI acquisitions, affecting in a different way each network and with a different variability for the three patients, as assessed by ratio of fitness. Moreover, combined PET/fMRI analysis demonstrated a higher functional/metabolic correlation for patients in EMCS and MCS compared to UWS. In conclusion, we observed for the first time, through a test-retest approach, a variability in the appearance and temporal/spatial patterns of resting-state networks in severely brain-injured patients, proposing a new method to select the most informative connectivity pattern.

  • Fatigue in Parkinson's disease: A systematic review and meta-analysis.

    Publication Date: 28/09/2018 on Movement disorders : official journal of the Movement Disorder Society
    by Siciliano M, Trojano L, Santangelo G, De Micco R, Tedeschi G, Tessitore A
    DOI: 10.1002/mds.27461

    We conducted a systematic review and meta-analysis aimed at establishing robust prevalence estimates and identifying clinical correlates of fatigue in PD. From 2,459 titles and abstracts, we selected 44 relevant studies (n = 7427 patients). Overall, the meta-analysis showed a prevalence of fatigue of 50% in PD. This prevalence estimate, however, was significantly moderated by study heterogeneity in measurement scales and cut-off thresholds. In contrast, demographic features, disease severity, cognitive impairment, and depression did not moderate prevalence estimates. Moreover, fatigue prevalence did not differ between de novo and treated PD patients. Compared to nonfatigued patients, fatigued patients had sligthly higher age (1.44 years), disease duration (0.93 years), l-dopa equivalent daily dose (50.89 units), UPDRS-III (4.99 points), and H & Y (0.33 points), as well as risk of comorbid depression (risk ratio = 1.89) and had a little lower MMSE score (-0.66 points). Fatigue was moderately associated with apathy (Hedges' g = 0.55), anxiety (Hedges' g = 0.67), daytime somnolence (Hedges' g = 0.43), sleep disturbances (Hedges' g = 0.66), and poorer quality of life (Hedges' g = 1.23). Our analyses suggest that fatigue is a frequent, independent nonmotor symptom in PD appearing early and persisting throughout the disease course, and that establishing uniform diagnostic criteria for PD-related fatigue is critical. In addition, several nonmotor symptoms appear to be associated with fatigue and negatively impact quality of life. Pharmacological and nonpharmacological interventions targeting fatigue and associated symptoms may improve quality of life in patients with PD. © 2018 International Parkinson and Movement Disorder Society.

  • Visual pursuit of one's own face in disorders of consciousness: a quantitative analysis.

    Publication Date: 30/07/2018 on Brain injury
    by Trojano L, Moretta P, Masotta O, Loreto V, Estraneo A
    DOI: 10.1080/02699052.2018.1504117

    Eye behaviour is important to distinguish minimally conscious state (MCS) from vegetative state (VS).

  • Cognitive performance in multiple sclerosis: the contribution of intellectual enrichment and brain MRI measures.

    Publication Date: 26/05/2018 on Journal of neurology
    by Santangelo G, Bisecco A, Trojano L, Sacco R, Siciliano M, d'Ambrosio A, Della Corte M, Lavorgna L, Bonavita S, Tedeschi G, Gallo A
    DOI: 10.1007/s00415-018-8905-9

    Cognitive reserve (CR) is a construct that originates from the observation of poor correspondence between brain damage and clinical symptoms. The aim of the study was to investigate the association between cognitive reserve (CR), brain reserve (BR) and cognitive functions and to evaluate whether CR might attenuate/moderate the negative impact of brain atrophy and lesion load on cognitive functions in multiple sclerosis (MS). To achieve these aims, ninety-eight relapsing-remitting MS patients underwent the brief repeatable battery of neuropsychological tests and Stroop test (ST). CR was assessed by vocabulary-based estimate of lifetime intellectual enrichment. All patients underwent a 3T MRI to assess T2-lesion load and atrophy measures, including normalized gray matter and white matter (nWMV) volumes. The BR was evaluated by maximal lifetime brain volume expressed by intracranial volume (ICV). Hierarchical regressions were used to investigate whether higher BR and/or CR is related to better cognitive performances after controlling for potentially confounding factors. The ICV was not associated with any cognitive tests. Intellectual enrichment was positively associated with performance on tests assessing memory, attention and information processing speed, verbal fluency and inhibitory control. Significant relationship between nWMV and ST was moderated by intellectual enrichment. In conclusion, the findings suggested that CR seems to mitigate cognitive dysfunction in MS patients and can reduce the negative impact of brain atrophy on inhibitory control, relevant for integrity of instrumental activities of daily living.

  • Do medical complications impact long-term outcomes in prolonged disorders of consciousness?

    Publication Date: 25/05/2018 on Archives of physical medicine and rehabilitation
    by Estraneo A, Loreto V, Masotta Psy O, Pascarella A, Trojano L
    DOI: 10.1016/j.apmr.2018.04.024

    to investigate medical complications (MC) occuring within 6 months post-injury in brain-injured patients with prolonged disorders of consciousness (DoC) and to evaluate impact of MC on mortality and long-term clinical outcomes.

  • Psychometric properties of the Italian version of the Cognitive Reserve Scale (I-CRS).

    Publication Date: 04/05/2018 on Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
    by Altieri M, Siciliano M, Pappacena S, Roldán-Tapia MD, Trojano L, Santangelo G
    DOI: 10.1007/s10072-018-3432-0

    The original definition of cognitive reserve (CR) refers to the individual differences in cognitive performance after a brain damage or pathology. Several proxies were proposed to evaluate CR (education, occupational attainment, premorbid IQ, leisure activities). Recently, some scales were developed to measure CR taking into account several cognitively stimulating activities. The aim of this study is to adapt the Cognitive Reserve Scale (I-CRS) for the Italian population and to explore its psychometric properties. I-CRS was administered to 547 healthy participants, ranging from 18 to 89 years old, along with neuropsychological and behavioral scales to evaluate cognitive functioning, depressive symptoms, and apathy. Cronbach's α, corrected item-total correlations, and the inter-item correlation matrix were calculated to evaluate the psychometric properties of the scale. Linear regression analysis was performed to build a correction grid of the I-CRS according to demographic variables. Correlational analyses were performed to explore the relationships between I-CRS and neuropsychological and behavioral scales. We found that age, sex, and education influenced the I-CRS score. Young adults and adults obtained higher I-CRS scores than elderly adults; women and participants with high educational attainment scored higher on I-CRS than men and participants with low education. I-CRS score correlated poorly with cognitive and depression scale scores, but moderately with apathy scale scores. I-CRS showed good psychometric properties and seemed to be a useful tool to assess CR in every adult life stage. Moreover, our findings suggest that apathy rather than depressive symptoms may interfere with the building of CR across the lifespan.