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.

  • Modulating interoception by insula stimulation: A double-blinded tDCS study.

    Publication Date: 17/12/2018 on Neuroscience letters
    by Sagliano L, Magliacano A, Parazzini M, Fiocchi S, Trojano L, Grossi D
    DOI: 10.1016/j.neulet.2018.12.022

    Interoception consists in the perception and processing of internal body signals, such as heartbeat. Previous neuroimaging studies revealed that attention to heartbeat activated bilateral insula and premotor regions. In the present double-blind study, we aimed at testing the role of insula in interoception by means of transcranial direct current stimulation (tDCS) interfering with its activity. Sixteen healthy participants responded to a questionnaire to evaluate the tendency to be internally focused and performed a heartbeat counting task before and after tDCS in three sessions (left insula stimulation, right insula stimulation, sham stimulation). Real and reported heartbeat were recorded and used to calculate the accuracy scores. A significant interaction between stimulation condition and time (pre- and post-stimulation) was found due to a significant improvement of the interoceptive accuracy in the sham condition only. Our results demonstrated that stimulation over the insula reduced the possibility to improve the precision with which individuals detect internal signals.

  • 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.

  • Bi-cephalic parietal and cerebellar direct current stimulation interferes with early error correction in prism adaptation: Toward a complex view of the neural mechanisms underlying visuomotor control.

    Publication Date: 01/12/2018 on Cortex; a journal devoted to the study of the nervous system and behavior
    by Panico F, Sagliano L, Grossi D, Trojano L
    DOI: 10.1016/j.cortex.2018.09.020

    Prism Adaptation (PA) represents a valid tool to assess short-term visuomotor plasticity. Two adaptive processes are involved during PA: recalibration, contributing to early error compensation, and spatial realignment, contributing to after-effect development. Classical models on PA posit that adaptive mechanisms underlying PA rely on segregated regions in the brain. Indeed, they ascribe recalibration to the activity of the Posterior Parietal Cortex (PPC) and spatial realignment to the activity of the Cerebellum. The present experiment challenges the idea of a clear-cut separation of the role of the brain areas involved in PA, proposing an interpretation in terms of interrelated brain regions. To this purpose we interfered with the activity of the PPC and the Cerebellum by means of complementary protocols of stimulation. Bi-cephalic transcranial Direct Current Stimulation was delivered simultaneously on the PPC and the Cerebellum during PA in two groups of participants receiving real stimulation with opposite polarities (anode on PPC and cathode on Cerebellum or vice-versa) and in a control group (Sham stimulation). Differences in mean errors between groups were analyzed. Results show that the two groups of real stimulation exhibited larger displacements in early error compensation compared to the Sham Group, but they did not differ from each other. No group difference was found in late error compensation and after-effect. In conclusion, the present findings provide the first direct evidence that a brain circuit connecting the PPC and the Cerebellum is involved in early stages of visuomotor adaptation, and pave the way for updating classical models of PA.

  • Left inferior parietal and posterior temporal cortices mediate the effect of action observation on semantic processing of objects: evidence from rTMS.

    Publication Date: 08/11/2018 on Psychological research
    by De Bellis F, Magliacano A, Sagliano L, Conson M, Grossi D, Trojano L
    DOI: 10.1007/s00426-018-1117-1

    Previous studies showed that motor information related to tool use (i.e., functional actions) could affect processing of objects semantic properties, whereas motor information related to grasping or moving tool (i.e., structural actions) cannot. However, little is known about the neural correlates mediating such interaction between motor and semantic information. Here, healthy participants performed a semantic judgment task requiring identification of semantic relations among objects, after observing a functional, a structural or a pointing action prime. In a within-subject design, during prime presentation the participants underwent repetitive transcranial magnetic stimulation (rTMS) over the left supramarginal gyrus (SMG), the left posterior middle temporal gyrus (pMTG) or received sham stimulation. Results showed that in the sham condition observing functional actions (vs. structural and pointing actions) favoured processing of semantic relations based on function similarity (i.e., taxonomic relations), but not of relations based on co-occurrence within an event schema (i.e., thematic relations). Moreover, stimulation of both left SMG and pMTG abolished the effect of functional action primes worsening subsequent judgment about taxonomic relations, and this effect was greater after pMTG stimulation. rTMS did not affect processing of thematic semantic relations. We suggest that action observation triggers activation of functional motor information within left inferior parietal cortex, and that integration between functional motor and conceptual information in left temporal cortex could impact high-level semantic processing of tools.

  • 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.

  • Neural correlates of apathy in patients with neurodegenerative disorders: an activation likelihood estimation (ALE) meta-analysis.

    Publication Date: 20/09/2018 on Brain imaging and behavior
    by Raimo S, Santangelo G, D'Iorio A, Trojano L, Grossi D
    DOI: 10.1007/s11682-018-9959-0

    Apathy is commonly reported in Alzheimer's Disease (AD), Fronto-Temporal Dementia (FTD) and Parkinson's Disease (PD). In our meta-analysis we analysed a total of 41 studies to identify brain patterns associated with apathy. For these purposes we used activation likelihood estimation meta-analyses. Our main overall analysis showed that apathy is associated to hypometabolism and a decreased gray matter volume in the left inferior frontal gyrus (BA 45, 46). Disorder-specific analyses, not performed by means of meta-analysis, because of the small number of studies, but by means a label-based review, revealed an altered brain perfusion and decreased gray matter volume in anterior cingulate cortex (BA 24, 32) in AD patients and a decreased gray matter volume in inferior frontal gyrus (BA 44, 45) and parietal cortex (BA 40) in FTD patients. These findings suggest that apathy is mainly associated with a cortical dysfunction of areas involved in executive-cognitive processing (i.e. action planning) and emotional regulation (auto-activation and reward processing). Knowledge about the neural underpinnings of apathy is crucial for understanding its clinical characteristics in neurodegenerative diseases and for developing novel strategies of treatment in clinical practice.