Ennio De Renzi (1924–2014). A loving remembrance

The editors of Functional Neurology, the staff of the Casimiro Mondino Foundation, and the Pavia neurology community note with great sadness the loss of Professor Ennio De Renzi (1924–2014), who passed away on November 9, 2014.

De Renzi was born in Cremona in 1924. In a recent autobiographical paper (De Renzi, 2006) he elegantly summed up the political climate of Italy during his youth. Italy was then engulfed in a “repressive, untruthful and boring” fascist dictatorship, which inexorably led the country into the catastrophe of World War II. He also described fighting in the antifascist Resistance and leaving the Faculty of Law to study medicine at the University of Pavia, where he was admitted to the prestigious Ghislieri College. He obtained his MD in 1950, and completed his specialization in neurology and psychiatry in 1953 at the Institute for Nervous and Mental Diseases, then directed by Carlo Berlucchi.

His first interest was clinical psychiatry, specifically, projective tests such as the Rorschach ink block test (De Renzi et al., 1957). However, he soon became frustrated by the difficulty of obtaining reliable and reproducible results from such tests, and, towards the end of the 50s, began to focus on behavioral disorders associated with cerebral lesions, developing a particular interest in aphasia.

Meanwhile, he had moved from Pavia first to Modena, and then to the Clinica delle Malattie Nervose e Mentali (Clinic of Nervous and Mental Diseases) of the University of Milan, where he found a suitable environment for his research. There he was able to study a large number of patients with diagnoses of focal lesions, particularly stroke and brain tumors. He informally founded the “Milan group”, the first nucleus of the Italian school of neuropsychology. Among the members of the group, first and foremost were the neurologist Luigi A. Vignolo (1934–2010), who had been trained in Paris before returning to Italy, and the psychologist and speech pathologist Anna (“Mimi”) Basso, who had also received training in Paris, and who established and directed the first Aphasia Rehabilitation Service in Italy. She later became Director of the School for Speech Language Pathologists of the University of Milan. They were soon joined by other young neurologists, including Hans Spinnler and Pietro (“Pierino”) Faglioni. I myself was privileged to join the group at that early stage, and to accompany De Renzi on his daily clinical rounds. I distinctly remember his clinical acumen, his vast knowledge, his empathy towards the patients, and his sense of humor. He conducted his rounds in a relaxed, yet very demanding, style, writing, sometimes to our dismay, incisive comments in pen and ink on our clinical reports.

Those early years saw several landmarks which contributed to establishing the position of De Renzi and the Milan group on the international scene. These included an article on the Token Test in Brain (De Renzi and Vignolo, 1962), which can be considered the first modern Italian neuropsychological study to be published in an international journal.

Together with the group he participated in the International Neuropsychological Symposium in 1964, beginning a period of work and personal friendships with neurologists and psychologists from various European countries, as well as the US and Canada (Fig. 1). He founded the journal Cortex, which he led as editor-in-chief for over 25 years.

Figure 1.

Participants at the International Neuropsychological Symposium (INS), which took place in S. Gimignano, Siena, Italy.

1st row from left (1–6) Ennio De Renzi, Brenda Milner, Martha Wilson, Hans-Lukas Teuber, Henry Hécaen, Carlo Gentili; 2nd row (7–11) Edoardo Bisiach, C. Faust, Mme I. Gloning, Elizabeth K. Warrington, Marcel Kinsbourne. 3rd row (12–18) Pietro Faglioni, Hans Hoff, F.G. von Stockert, Josephine Semmes, Norman Geschwind, Klaus Poeck, Colwyn Trevarthen. 4th row (19–21) Hans Spinnler, R. Quatember, Luigi A. Vignolo. 5th row (22–25) François Boller, George Ettingler, Sue and John Oxbury.

In 1964, the North American psychologist Arthur Benton (1909–2006) taught a two-month course in Milan. De Renzi and Vignolo’s translation of Benton’s lectures (Benton, 1966) was the first textbook on neuropsychology published in Italy, and it played an important role in spreading this culture among neurologists and psychologists.

From the beginning, De Renzi established a standard of experimental methodology for the group. The approach was based primarily on quantitative assessment of the cognitive ability of interest in left- and right-brain-damaged patients, and in neurologically unimpaired participants (controls), by means of ad hoc devised and standard tests, followed by statistical comparison of the patients and controls’ performances, taking into account, and partialling out the influence of sex, age, education, duration of disease, and other possibly relevant factors. Faglioni was the principal developer of these advanced statistical methods.

The group focused mainly on hemispheric differences in higher-order mental processes. Two sets of results may be mentioned: the greater and more frequent impairment of spatial abilities consequent to right than to left hemispheric damage; and the different patterns of impairment of stimulus recognition after unilateral hemispheric damage: the right hemisphere proved to be more involved in the perceptual discrimination of the qualities of the stimulus, the left one in its identification (“recognition”, with retrieval of its semantic associations). This hemispheric asymmetry held for visual material (and also involved color processing) and for auditory stimuli.

In subsequent years, De Renzi continued to be a prominent and productive researcher as well as a superb teacher. His book Disorders of Space Exploration and Cognition (De Renzi, 1982) is a classic. The people whose professional lives and thinking were influenced by him are too numerous to be listed here. Many of them went on to enjoy productive careers of their own. To mention only a few, Luigi Vignolo became Chair of the Department of Neurology at the Brescia University Medical School; Hans Spinnler became Director of the Third Neurological Clinic of Milan University at the San Paolo Hospital; Pietro Faglioni became Chair of the Department of Neurology of Modena University which is now directed by Paolo Nichelli; Giuseppe Vallar is the current Director of the Specialty School of Neuropsychology at the University of Milano-Bicocca; and Sergio Della Sala is the current Editor-in-Chief of Cortex.

Following his retirement in 2000, Ennio ostensibly focused his interest on other areas, becoming an assiduous visitor to the wonderful Modena Library, where he could be found just about every afternoon. He also very much enjoyed keeping in touch with his former pupils. In particular, I wish to recall a touching contribution he made on the occasion of a symposium entitled “Modern Italian Neuropsychology: Origins, Developments and Future Perspectives” organized by Giuseppe Vallar and Guido Gainotti and held in Como in May 2013. Ennio made a brilliant keynote introduction and participated actively in the entire symposium. He also thoughtfully reviewed a recent article summarizing the history of neuropsychology in Italy (Vallar et al., 2014). We are grateful to him, too, for these last contributions to neuropsychology.

Ennio is survived by his wife Margherita (known to us as Rita), and by his three children, Roberto, Silvia and Valentina. We express our condolences to them. They have lost a husband and a father. We have lost a precious friend.