Cognitive Troubles Research Articles

Perfil cognitivo em idosas de dois serviços públicos em São Luís - MA

CONTEXTO: Este estudo procurou estabelecer, sob o ponto de vista descritivo, o nível de cognição e variáveis sociodemográficas associadas em mulheres da sétima à nona década, em dois serviços públicos, na cidade de São Luís (MA). OBJETIVOS: Estudar o nível de cognição pelo Miniexame do Estado Mental (MMSE) e variáveis sociodemográficas associadas em mulheres da sétima à nona década, em dois serviços públicos, na cidade de São Luís (MA). MÉTODOS: Durante quatro meses um questionário com as variáveis sociodemográficas e o Miniexame do Estado Mental (MMSE) foram aplicados em pacientes ambulatoriais. As voluntárias foram avaliadas nos ambulatórios de Neurologia do Hospital Universitário Presidente Dutra e do Hospital Estadual Carlos Macieira. RESULTADOS: Oitenta pacientes foram avaliadas - 31,2% foram classificadas com transtorno cognitivo ao MEEM; 71,4% destas tinham entre 81 e 85 anos. Transtorno cognitivo estava presente em 65% das pacientes com nível educacional inferior a sete anos. Em relação ao nível de renda e cognição, foi observado que 30,4% das pacientes que apresentavam nível de renda menor que um a dois salários mínimos eram classificadas com transtorno cognitivo. Das 33 voluntárias que tinham cuidador direto, 57,6% apresentavam transtorno cognitivo. CONCLUSÕES: O estudo torna-se de relevância, pois permite se atentar para o problema na região e serve de estímulo para estudos metodológicos mais complexos, visando promover a saúde pública mental do idoso.

P.10 Evaluation of standard chemo-radiotherapy in older patients with locally advanced non-small cell lung cancer (NSCLC) enrolled in a multicenter randomized phase II study

Background: More than half of cancers occur after the age of 65 and this should grow progressively. Unfortunately elderly people are rarely included in therapeutic surveys and in screening tests, so they miss optimal treatment of their cancer (surgery, chemotherapy, radiotherapy) most of the time. At the Ambroise Pare academic hospital, a 440 beds urban hospital, a geriatric intervention team (GIT) has been created since February 2004. One of its aims is to help others specialists to assess the better treatment for their patients. Patients: In 3 years, 2800 evaluations were done by the GIT in the whole hospital, 234 on inpatients of the pneumology department. On those, 53 were hospitalised for the diagnosis or the treatment of a cancer. Results: Patients average age was 80±6 years old, 53% were female. The mini-GDS was positive in 53% and a time and space disorientation was observed in 41%. 67% patients had cognitive troubles, with high risk of falls for 86%. In 28%, patients received a chemotherapy. In the end, 4 groups of patients could be observed “primary” (2%) who will have an optimal treatment “intermediate” (37%) at whom will be proposed an adjusted treatment “secondary”(50%) who will have a symptomatic treatment “near death” (11%) with palliative care Conclusion: This collaboration have afforded us to identify better patients likely to receive an optimal treatment. The main contribution of the EIG in this collaboration was to afford a fast geriatric assessment to the others physicians in order to make up one’s mind to the best treatment.

Les troubles anxiodépressifs dans la maladie de Parkinson : une revue de la littérature

For a long time, depression and anxiety have been neglected in Parkinson’s disease in favour of motor impairments. Since the 70’s and the beginning of the dopatherapy, the psychopathological perturbations are more and more considered, including by the neurologists. The aim of this study is to review the main studies related to depression and anxiety in Parkinson’s disease. Four main topics are tackled in this review: The prevalence, the etiology and the semiology of the depression as well as the anxiety disorders; the assessment tools and methodological problems for assessing these troubles. Beside these main subjects, we adress some interesting questions, which concern patients as well as clinicians, like the relationship between the depression and/or anxiety and the motor impairments, the disease duration and the type of the Parkinson’s disease. We tackle also the question of the relationship between the depression and/or anxiety and the cognitive troubles and we focus about the main types of cognitive impairment found in Parkinson’s disease with depression and anxiety. We review some studies, which found a link between psychic disorders and depression. It is now obvious that the deep brain stimulation has become an efficient treatment of motor symptoms. In this review, we focus on the effect of the deep brain stimulation on depression. We also discuss the different treatment available for depression and anxiety in Parkinson’s disease. Because of their frequency and their impact on the quality of life, it is particularly important to give a specific attention to these troubles in Parkinson’s disease.

Abnormal retinal thickness in patients with mild cognitive impairment and Alzheimer's disease

In Alzheimer's disease (AD), brain lesions are marked by severe neuronal loss and retinal degeneration was previously mentioned in affected patients. Mild cognitive impairment (MCI) is a clinical syndrome that could be an early phase of AD. In this study, using optical coherence tomography (OCT), the retinal nerve fiber layer (RNFL) thickness was assessed in patients with mild AD, moderate to severe AD, amnestic MCI and control subjects. The results show that RNFL thickness is statistically reduced in patients with MCI, mild AD or moderate to severe AD compared to controls. In addition, no statistical difference was found between the results in MCI patients and mild AD patients. The RNFL seems to be involved early during the course of amnestic MCI and OCT tests could be carried out in patients with cognitive troubles.

The adult form of Niemann-Pick disease type C

Niemann-Pick disease type C (NPC) is a fatal neurovisceral lipid storage disease of autosomal inheritance resulting from mutations in either the NPC1 (95% of families) or NPC2 gene. The encoded proteins appear to be involved in lysosomal/late endosomal transport of cholesterol, glycolipids and other molecules but their exact function is still unknown. The clinical spectrum of the disease ranges from a neonatal rapidly fatal disorder to an adult-onset chronic neurodegenerative disease. Based upon a comprehensive study of 13 unrelated adult patients diagnosed in France over the past 20 years as well as the analysis of the 55 other cases published since 1969, we have attempted to delineate the major clinical, radiological, biochemical and genotypic characteristics of adult NPC. Overall, mean age at onset (+/-SD) of neuropsychiatric symptoms was 25 +/- 9.7 years. The diagnosis of NPC was established after a mean delay of 6.2 +/- 6.4 years and the mean age at death (calculated from 20 cases) was 38 +/- 10.2 years. Major clinical features included cerebellar ataxia (76%), vertical supranuclear ophthalmoplegia (VSO, 75%), dysarthria, (63%), cognitive troubles (61%), movement disorders (58%), splenomegaly (54%), psychiatric disorders (45%) and dysphagia (37%). Less frequent signs were epilepsy and cataplexy. During the course of the disease, clinical features could be subdivided into (i) visceral signs (hepatomegaly or splenomegaly), (ii) cortical signs (psychiatric cognitive disorders and epilepsy); and (iii) deep brain signs (VSO, ataxia, movement disorders, dysarthria, dysphagia, cataplexy) which exhibited different evolution patterns. Asymptomatic and non-evolutive visceral signs were often noticed since early childhood (38.5% of our patients), followed by mild cortical signs in childhood (learning difficulties) and early adulthood (62% of cases among which 38% were psychiatric disorders). Deep brain signs were observed in 96% of patients and were usually responsible for death. In general, there was a good correlation between clinical signs and the localization of brain atrophy on MRI. The 'variant' biochemical phenotype characterized by mild abnormalities of the cellular trafficking of endocytosed cholesterol was over-represented in the adult form of NPC and seemed associated with less frequent splenomegaly in childhood and lesser psychiatric signs. Involvement of the NPC1 gene was shown in 33 families and of the NPC2 gene in one. Improving the knowledge of the disease among psychiatrists and neurologists appears essential since emerging treatments should be more efficient at the visceral or cognitive/psychiatric stages of the disease, before the occurrence of widespread deep brain neurological lesions.

Neurological manifestations and neuroradiological presentation of Erdheim-Chester disease: report of 6 cases and systematic review of the literature

Erdheim-Chester disease (ECD) is a rare, non-Langerhans form of histiocytosis of unknown etiology that affects multiple organs. We report 6 cases of ECD with neurological involvement and neuroradiological abnormalities on brain MRI. A literature review revealed 60 other cases of ECD with neurological involvement. We therefore analyzed 66 ECD patients with neurological involvement. Cerebellar and pyramidal syndromes were the most frequent clinical manifestations (41% and 45% of cases), but seizures, headaches, neuropsychiatric or cognitive troubles, sensory disturbances, cranial nerve paralysis or asymptomatic lesions were also reported. Neurological manifestations were always associated with other organ involvement, especially of bones (at least 86%) and diabetes insipidus (47%). Neurological involvement was responsible for severe functional handicaps in almost all patients and was responsible for the death of 6 of the 66 patients (9%). Neuroradiological findings could be separated into three patterns: the infiltrative pattern (44%), with widespread lesions, nodules or intracerebral masses, the meningeal pattern (37%), with either thickening of the dura mater or meningioma-like tumors, and the composite pattern (19%), with both infiltrative and meningeal lesions.

La neurosyphilis : une cause rare de démence

Introduction Neurosyphilis had to be evoked in the face of an atypical dementia. Case record We described a case of an 65-year-old man who has presented a neurosyphilis suspected in front of behavioural and cognitive troubles in context of risk sexual behavioural and confirmed by serologic tests in the cerebrospinal fluid. Discussion This case proves the necessity to research a neurosyphilis in subjects with a dementia syndrome which not corresponds to classic etiologies.

La philosophie à l’école de la pensée trouble

Under the impulse of the UE and of other world agencies such as the UN, Special Education in France has witnessed for the past ten years an acceleration in an evolution started more than a century ago. If the special ed teacher remains free to adjust his/ her pedagogy to his/ her professional situation, simultaneously he/ she is expected to develop any means allowing the special need child’s or adolescent’s integration to main stream education, as well as to encourage the acquisition of standard competencies as they are defined for every child in France. Facing these changes activities with a philosophical target in special education must respond to a legal and ethical framework that recognizes the special need child or adolescent the same learning rights as main stream students. This remains to be defined in the context of an innovative pedagogy. Beyond ethical principles generating activities of a philosophical nature for psychotic children or for children with deep cognitive troubles is particularly complex. Far from being impossible, it necessitates certain precautions (the idea of a reassuring psychological, sociological, and emotional framework) and the laying down of specific groundwork (such as thinking guidance).

Pour une clinique lacanienne des psychoses: À propos de...« L’inconscient à ciel ouvert de la psychose » de Colette Soler

L’objectif de cette recherche est d’analyser les modalités de développement de l’estime de soi d’élèves en situation de handicap scolarisés en classes d’inclusion scolaire (CLIS), en appréhendant les effets du type d’inclusion pratiquée (individuelle et/ou collective) du genre et de l’âge.Quarante élèves scolarisés dans 6 CLIS et présentant une déficience intellectuelle légère (20 filles ; 20 garçons), âgés de 7 à 12 ans (M = 10,15 ; ET = 2,08) ont renseigné la version française de l’échelle auto-évaluative Self Perception Profile for Children (Harter, 1985) traduite par Pierrehumbert, Plancherel et Jankech-Caretta (1987). Parmi ces élèves, 45 % étaient inclus individuellement, 37,5 % collectivement et 17,5 % inclus individuellement et collectivement.Les élèves bénéficiant d’inclusion individuelle mais aussi d’inclusions individuelle et collective ont un niveau d’estime de soi « Sociale » plus élevé que les élèves bénéficiant uniquement d’inclusion collective. Le niveau d’estime de soi « Sociale » est modulé par un effet d’interaction entre le genre et l’âge des élèves. Ce dernier influence également le niveau d’estime de soi « Valeur propre ».Les résultats soulignent l’importance des processus de comparaison sociale dans la construction de l’estime de soi des élèves scolarisés en CLIS. Ces derniers cherchent à maintenir une position d’exception, possible par la pratique d’inclusion individuelle, qui contribuerait à les valoriser.The aim of this study is to analyze self-esteem development of disabled pupils schooled in an inclusive classrooms (CLIS). Recent laws emphasize the importance of disabled people's inclusion in ordinary places. Concerning primary school, this is materialized by CLIS which are classes hosting disabled children in an ordinary school. In this configuration, disabled pupils must have inclusion time in another classroom of the school, in an individual way (a pupil joins another classroom) and/or in a collective way (the CLIS joins another classroom). Those inclusions would deliver pedagogic, educational and personal benefits. Specifically, concerning personal benefits, CLIS would give to these pupils possibility to feel appreciated. To our knowledge, no study has focused on the impact of type of inclusion applied in CLIS on self-esteem levels of disabled children; while this seems to be a substantial factor in self-esteem modulation. The inclusion applied even individual and/or collective, the age and gender of pupils are they factors suspected to guide self-esteem? We focus on the Harter model (1986) related to multidimensional and hierarchic self-esteem. We also refer to Martinot (2002) who develops different self-esteem protection strategies and to the Marsh model (1987) concerning the “Big fish little pond effect”.Forty pupils with cognitive troubles schooled into six CLIS (20 girls and 20 boys), aged 7 to 12 years old (A = 10.15; SD = 2.08), filled the French version of the Harter questionnaire (1985): Self Perception Profile for Children translated by Pierrehumbert, Plancherel and Jankech-Caretta (1987). Forty-five percent of the pupils are individually included, 37.5 % are collectively included and 17.5 % are both included individually and collectively.Our results reveal that pupils individually included and with both inclusions have a social self-esteem higher that those who are only collectively included. Social self-esteem is modulated by the effect of interaction between age and gender. The age of the pupils is influencing the global self-esteem.Results underline the weight of social comparison in self-esteem structure of pupils schooled in CLIS. Those who seek to maintain favored status in order to valorize themselves, which seems to be feasible by individual inclusion. Considering these results would directly influence the daily practice of professionals close to these pupils.

Information processing in autistic children: more sequential or more simultaneous?

The objective of this study was to refine the understanding of cognitive troubles in autism and to clarify the modes of information processing mobilized by the subjects. Eight children were examined, aged 4;9–9;1, with a diagnosis of moderate autism. The Kaufman Assessment Battery for Children (K-ABC) was presented to each child. The results support an executive functioning deficit interpretation and a weak drive for central coherence in autism. Practical implications of this study in terms of follow up are also discussed.

Demencia con atrofia frontal: estudio clínico de 18 pacientes con deterioro intelectual y degeneración de los lóbulos frontales según la neuroimagen

To characterize clinically patients with cognitive impairment and frontal lobe degeneration at neuroimaging.Patients diagnosed of dementia or mild neurocognitive impairment by DSM IV criteria and neuropsychological tests with frontal lobe atrophy and hipoperfusion detected by computed tomography and single photon emission computed tomography.18 patients, 5:1 on behalf of women; mean age at onset, 74 years; hereditary for dementia, 38%; mean duration of illness at first testing, 2 years; the most common initial symptoms, memory loss. At initial examination, psychotic or behavioral impairment was found in 61% and parkinsonism in 38%, the commonest cognitive troubles at this moment was the executive function, language and anterograde memory dysfunctions at the same rate. Frontal lobe atrophy and hypoperfusion was found in 100%, temporal in 88% and parietal in 38%. Electroencephalogram was pathological in 33%. The course of the disease was progressive but with fluctuation in 27%. Frontotemporal dementia clinical criteria in 13 patients, 4 of them clinical criteria of dementia with Lewy bodies too, and clinical criteria of Alzheimer s disease in 5.

Cognitive Dysfunction in Alcohol Withdrawal

A longitudinal descriptive clinical study of a homogeneous population of alcoholic patients was conducted to characterize the cognitive troubles (frequency, type and evolution) associated with heavy d

Functional disorganization of representations in schizophrenia.

The first part of this article describes a model of disorganization of representations in schizophrenia. We assume that subjects with schizophrenia have some interfering activity in memory. Such an interfering activity induces a functional decontextualization of information and the reciprocal is true. This model accounts for different classes of cognitive troubles that have been observed in schizophrenia. In the second part, we describe a text-comprehension experiment that studies two paradigmatic cases of episodic and semantic contextualization of information: the "compartmentalization" and the "thematization" of fictional narratives. Compartmentalization refers to the way in which representations of different narratives are separated in memory; thematization refers to the way in which representations of one narrative are structured in function of a theme. In our experiment, compartmentalization and thematization are assessed by a method of priming in word recognition. In agreement with our model, the results show that subjects with schizophrenia are impaired in compartmentalization and thematization when compared with anxious-depressed subjects.

Spasmes infantiles epileptiques benins

Among 100 infants with infantile spasms studied before treatment, 14 had idiopathic spasms with a favourable outcome. They had a normal development, including reaching for objects before the age of 5 months and moderate regression without loss of eye following. Although it was hysarhythmic, the EEG tracing showed identifiable basic activity and sleep spindles; there was no slow waves focus even after diazepam administration and the spasms were "independent" even during a cluster. This type of infantile spasms seems to be a particular type of non-lesional epilepsy. It contrasts with idiopathic spasms of unfavourable outcome that apparently result from a preexisting and overlooked focal lesion responsible of later cognitive troubles.