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


  • Standard EEG in diagnostic process of prolonged disorders of consciousness.

    Publication Date: 01/06/2016 on Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology
    by Estraneo A, Loreto V, Guarino I, Boemia V, Paone G, Moretta P, Trojano L
    DOI: 10.1016/j.clinph.2016.03.021

    This cross-sectional study assessed the ability of standard EEG in distinguishing vegetative state (VS) from minimally conscious state plus (MCS+) or MCS minus (MCS-), and to correlate EEG features with aetiology and level of responsiveness assessed by Coma Recovery Scale-Revised (CRS-R).

  • Cerebellar cathodal tDCS interferes with recalibration and spatial realignment during prism adaptation procedure in healthy subjects.

    Publication Date: 01/06/2016 on Brain and cognition
    by Panico F, Sagliano L, Grossi D, Trojano L
    DOI: 10.1016/j.bandc.2016.03.002

    The aim of this study is to clarify the specific role of the cerebellum during prism adaptation procedure (PAP), considering its involvement in early prism exposure (i.e., in the recalibration process) and in post-exposure phase (i.e., in the after-effect, related to spatial realignment). For this purpose we interfered with cerebellar activity by means of cathodal transcranial direct current stimulation (tDCS), while young healthy individuals were asked to perform a pointing task on a touch screen before, during and after wearing base-left prism glasses. The distance from the target dot in each trial (in terms of pixels) on horizontal and vertical axes was recorded and served as an index of accuracy. Results on horizontal axis, that was shifted by prism glasses, revealed that participants who received cathodal stimulation showed increased rightward deviation from the actual position of the target while wearing prisms and a larger leftward deviation from the target after prisms removal. Results on vertical axis, in which no shift was induced, revealed a general trend in the two groups to improve accuracy through the different phases of the task, and a trend, more visible in cathodal stimulated participants, to worsen accuracy from the first to the last movements in each phase. Data on horizontal axis allow to confirm that the cerebellum is involved in all stages of PAP, contributing to early strategic recalibration process, as well as to spatial realignment. On vertical axis, the improving performance across the different stages of the task and the worsening accuracy within each task phase can be ascribed, respectively, to a learning process and to the task-related fatigue.

  • Psychometric properties of the Italian version of the multifactorial memory questionnaire for adults and the elderly.

    Publication Date: 01/05/2016 on Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
    by Raimo S, Trojano L, Siciliano M, Cuoco S, D'Iorio A, Santangelo F, Abbamonte L, Grossi D, Santangelo G
    DOI: 10.1007/s10072-016-2562-5

    Reliable and valid metamemory measures are needed to assess subjective memory complaints that can be distinct from objective memory performance. The Multifactorial Memory Questionnaire (MMQ) evaluates dimensions of subjective memory functioning such as frequency of memory problems (Ability), affect related to memory abilities (Contentment), and strategy use in everyday life (Strategy). To examine the psychometric properties of the Italian version of the MMQ, six hundred Italian healthy individuals (aged 25-91 years) completed MMQ, a questionnaire assessing metacognition (Cognitive Failures Questionnaire, CFQ) and two batteries assessing cognitive global status (Montreal Cognitive Assessment, MoCA; Mini Mental State Examination, MMSE). MMQ was easy to administer, acceptable, and had good test-retest reliability (r for the total MMQ score 0.95), and internal consistency (Cronbach's α for the total MMQ score = 0.83). An exploratory factor analysis provided a four-factor solution: "Ability" (α = 0.99), "Contentment" (α = 0.91), "External Strategies" (α = 0.85) and "Internal Strategies" (α = 0.78) factors. MMQ total score and MMQ-Ability factor score showed good convergent validity when compared to CFQ score (r rho ≥ 0.51), whereas MMQ total score and the four MMQ factors showed good divergent validity when compared to MoCA and MMSE score (r rho ≤ 0.27). Demographic variables significantly influenced MMQ total score and most subscale scores. From the derived linear equations, we computed correction factors for raw scores and percentile distribution of adjusted scores. The Italian version of MMQ is reliable and valid to assess dimensions of metamemory in adult and elderly subjects.

  • Drawing Disorders in Alzheimer's Disease and Other Forms of Dementia.

    Publication Date: 21/04/2016 on Journal of Alzheimer's disease : JAD
    by Trojano L, Gainotti G
    DOI: 10.3233/JAD-160009

    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.

  • Dysfunctional Freezing Responses to Approaching Stimuli in Persons with a Looming Cognitive Style for Physical Threats.

    Publication Date: 19/04/2016 on Frontiers in psychology
    by Riskind JH, Sagliano L, Trojano L, Conson M
    DOI: 10.3389/fpsyg.2016.00521

    Immobilizing freezing responses are associated with anxiety and may be etiologically related to several anxiety disorders. Although recent studies have sought to investigate the underlying mechanisms in freezing responses that are so problematic in many forms of anxiety, cognitive factors related to anxiety have not been investigated. This study was designed to investigate the potential moderating role of a well-documented cognitive vulnerability to anxiety, the Looming Cognitive Style (i.e., LCS; Riskind et al., 2000), which assesses the extent to which individuals tend to routinely interpret ambiguous threats (e.g., physical or social threats) in a biased manner as approaching. We assessed participants' Reaction Times (RTs) when they made judgments about images of animals that differed in threat valence (threat or neutral) and motion direction (approach or recede). As expected, LCS for concerns about the approach of physical dangers appeared to moderate freeze reactions. Individuals who were high on this LCS factor tended to generally exhibit a freeze-response (slower RTs) and this was independent of the threat valence or motion direction of the animals. These general freezing reactions were in stark contrast to those of individuals who were low on the LCS factor for concerns about the approach of physical dangers. These participants tended to exhibit more selective and functional freezing responses that occurred only to threatening animals with approach motion; they did not exhibit freezing to neutral stimuli or any stimuli with receding motion. These findings did not appear to be explicable by a general slowing of RTs for the participants with high LCS. Moreover, the LCS factor for concerns about social threats (such as rejection or embarrassment) was not related to differences in freezing; there was also no additional relationship of freezing to behavioral inhibition scores on the Behavioral Inhibition System and the Behavioral Activation System Scales (BIS/BAS). It may prove fruitful to further explore cognitive factors related to anxiety to develop a more comprehensive understanding of how these factors are associated with anxiety-related freezing responses.

  • A clinical study on closing-in in focal brain-damaged individuals.

    Publication Date: 15/04/2016 on Journal of the neurological sciences
    by De Lucia N, Grossi D, Trojano L
    DOI: 10.1016/j.jns.2016.02.059

    In visuo-constructional assessment, brain-damaged individuals may copy figures near to or superimposed on the model, showing the Closing-in (CI). CI has been largely investigated in dementia, and often ascribed to impairments of the attention/executive abilities ("Attraction hypothesis"). Only a few dated studies investigated frequency of CI in brain-damaged individuals, without clarifying the genesis of the phenomenon. We aimed at testing the "Attraction hypothesis" in 27 individuals with focal frontal cortical or sub-cortical brain lesions by a dual-task experimental paradigm. The participants underwent a neuropsychological battery and a copying task to be performed alone (single task condition), or concurrently with a simple or a complex verbal secondary task (dual-task conditions). CI was found in 66% of frontal-damaged individuals, who scored significantly lower than healthy adults on all neuropsychological measures; brain-damaged individuals showing CI performed worse than frontal-damaged individuals without CI on frontal and visuo-constructional measures. In the dual-task condition with the complex secondary task CI was significantly enhanced, with a weaker tendency to self-correction, in individuals with CI compared to individuals without CI. These findings would confirm that the CI in brain-damaged individuals is related to reduction of attentional resources, consistently with the "Attraction hypothesis".

  • Psychometric properties and validity of Beck Depression Inventory II in multiple sclerosis.

    Publication Date: 01/04/2016 on European journal of neurology
    by Sacco R, Santangelo G, Stamenova S, Bisecco A, Bonavita S, Lavorgna L, Trojano L, D'Ambrosio A, Tedeschi G, Gallo A
    DOI: 10.1111/ene.12932

    Depression is the most common psychiatric disorder in multiple sclerosis (MS). Self-report depression scales are frequently used as screening, diagnostic and grading instruments. This study investigated the psychometric properties of the Beck Depression Inventory second edition (BDI-II) for assessing depressive disorders in a sample of Italian MS patients.

  • Aging and the subjective experience of time.

    Publication Date: 01/04/2016 on Aging clinical and experimental research
    by Crisci C, Caccavale M, Trojano L
    DOI: 10.1007/s40520-015-0403-7

    The subjective experience of time involves several, not yet identified, mechanisms. Many cognitive and emotional factors, such as attention, memory and subjective mental states can influence time estimation.

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

    Publication Date: 01/04/2016 on European journal of physical and rehabilitation medicine
    by Lanzillo B, Loreto V, Calabrese C, Estraneo A, Moretta P, Trojano L

    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.

  • Recognition disorders for famous faces and voices: a review of the literature and normative data of a new test battery.

    Publication Date: 01/03/2016 on Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
    by Quaranta D, Piccininni C, Carlesimo GA, Luzzi S, Marra C, Papagno C, Trojano L, Gainotti G
    DOI: 10.1007/s10072-015-2437-1

    Several anatomo-clinical investigations have shown that familiar face recognition disorders not due to high level perceptual defects are often observed in patients with lesions of the right anterior temporal lobe (ATL). The meaning of these findings is, however, controversial, because some authors claim that these patients show pure instances of modality-specific 'associative prosopagnosia', whereas other authors maintain that in these patients voice recognition is also impaired and that these patients have a 'multimodal person recognition disorder'. To solve the problem of the nature of famous faces recognition disorders in patients affected by right ATL lesions, it is therefore very important to verify with formal tests if these patients are or are not able to recognize others by voice, but a direct comparison between the two modalities is hindered by the fact that voice recognition is more difficult than face recognition. To circumvent this difficulty, we constructed a test battery in which subjects were requested to recognize the same persons (well-known at the national level) through their faces and voices, evaluating familiarity and identification processes. The present paper describes the 'Famous People Recognition Battery' and reports the normative data necessary to clarify the nature of person recognition disorders observed in patients affected by right ATL lesions.