Our data confirm that cognitive impairment in MS is multifactorial. The performances in the subdomain of verbal memory are predicted by SAI. These results favour the hypothesis of grey matter involvement and suggest a role of acetylcholine dysfunction in the pathogenesis of some aspects of cognitive deficits in MS.

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IMPORTANCEAlthough sparse observational studies have suggested a link between migraine and cervical artery dissection (CEAD), any association between the 2 disorders is still unconfirmed. This lack of a definitive conclusion might have implications in understanding the pathogenesis of both conditions and the complex relationship between migraine and ischemic stroke (IS).OBJECTIVE To investigate whether a history of migraine and its subtypes is associated with the occurrence of CEAD. DESIGN, SETTING, AND PARTICIPANTSA prospective cohort study of consecutive patients aged 18 to 45 years with first-ever acute ischemic stroke enrolled in the multicenter Italian Project on Stroke in Young Adults was conducted between January 1, 2000, and June 30, 2015. In a case-control design, the study assessed whether the frequency of migraine and its subtypes (presence or absence of an aura) differs between patients whose IS was due to CEAD (CEAD IS) and those whose IS was due to a cause other than CEAD (non-CEAD IS) and compared the characteristics of patients with CEAD IS with and without migraine. MAIN OUTCOMES AND MEASURESFrequency of migraine and its subtypes in patients with CEAD IS vs non-CEAD IS. RESULTSOf the 2485 patients (mean [SD] age, 36.8 [7.1] years; women, 1163 [46.8%]) included in the registry, 334 (13.4%) had CEAD IS and 2151 (86.6%) had non-CEAD IS. Migraine was more common in the CEAD IS group (103 [30.8%] vs 525 [24.4%], P = .01), and the difference was mainly due to migraine without aura (80 [24.0%] vs 335 [15.6%], P < .001). Compared with migraine with aura, migraine without aura was independently associated with CEAD IS (OR, 1.74; 95% CI, 1.30-2.33). The strength of this association was higher in men (OR, 1.99; 95% CI, 1.31-3.04) and in patients 39.0 years or younger (OR, 1.82; 95% CI,). The risk factor profile was similar in migrainous and non-migrainous patients with CEAD IS (eg, hypertension, 20 [19.4%] vs 57 [24.7%], P = .29; diabetes, 1 [1.0%] vs 3 [1.3%], P > .99). CONCLUSIONS AND RELEVANCEIn patients with IS aged 18 to 45 years, migraine, especially migraine without aura, is consistently associated with CEAD. This finding suggests common features and warrants further analyses to elucidate the underlying biologic mechanisms.

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A study of regional differences in prevalence of primary adult lactose malabsorption in Italy was conducted on 205 subjects. Their origin was determined by their grandparents' birthplace, 89 from northern, 65 from central, and 51 from southern areas of Italy. Lactose malabsorption was diagnosed with standard oral lactose tolerance test and blood glucose determinations. Lactose malabsorbers showed symptoms more frequently than absorbers after the test load of lactose (p less than 0.01) they also reported milk intolerance more frequently (p less than 0.01). Prevalence of lactose malabsorption is significantly lower in the central sample (19%) than in the northern (52%) and southern (41%) samples (p less than 0.01). This finding contrasts with the hypothesis of a continuous increase in frequency of lactose malabsorption from northern to southern Europe and is probably due to the complex genetic history of the Italian population.