Plainte mnésique et vieillissement (implication des processus automatiques et contrôlés)

La plainte mnésique constitue un des premiers motifs de consultation en Neuro-Gériatrie mais elle reste encore mal comprise et demeure souvent cantonnée à l expression d une symptomatologie anxieuse, dépressive ou métacognitive. Or l âge s accompagne d une moindre efficience des processus contrôlés et d un respect des processus automatiques. Notre thèse soutient que la plainte mnésique résulte de l interaction entre une modification subjective liée à une prise de conscience métacognitive et une moindre efficience objective de la récupération consciente. Aussi, nous avons créé une Epreuve de Glissement de Mémoire, adaptée à la situation d examen, selon la Procédure de Dissociation des Processus de Jacoby (1991) et le paradigme d Habituation de Hay et Jacoby (1996; 1999). En recréant expérimentalement des erreurs de glissement commises dans la vie quotidienne, cette épreuve permet d estimer l influence de la récupération consciente et de l habitude dans la performance mnésique. Par des aller-retour entre des patients souffrant d affections neurologiques (e.g., Troubles Cognitifs Légers ; Maladie d Alzheimer) ou psychopathologiques (e.g., Dépression) et des sujets témoins, nous avons étudié et validé les caractéristiques métrologiques de notre outil. Enfin, nous avons examiné l implication des processus automatico-contrôlés dans la plainte mnésique. Nos résultats montrent que la doléance cognitive diffère qualitativement avec le vieillissement en termes de processus mnésiques et de croyances métacognitives. Nos travaux considèrent la plainte mnésique comme un état de conscience émergeant d une interaction dynamique entre les intentions du sujet et le support environnemental.Whereas subjective memory complaint is very common in later life, it remains an open question whether memory complaint does actually indicate cognitive impairment, because of its weak correlations with results on classic tests. In one hand, consensus is reached about an existing association between memory complaint and depression, anxiety or metacognitive decreased abilities. In another hand, previous researches have found selective age-related impairment in controlled influences of memory (recollection) in the presence of preserved automatic influences (habit). We argued that memory complaint results from an interaction between a subjective metacognitive awareness and a deficit in recollection. Using the Hay & Jacoby s Habit paradigm (1996; 1999), an extension of the Jacoby s (1991) Process-Dissociation Procedure, we have created a memory-slip test to separate the contribution of habit and recollection in a cued-recall task. By validating our tool, we showed that because a deficit of recollection, the effects of habit are sometimes left unopposed in middle-aged, older adults, depressed subjects, patients who suffer from Mild Cognitive Impairment and patients who suffer from Alzheimer Disease. It increased the likelihood that they will produce memory slips and that they will complain greater than control groups do about their memory (excepted in AD). Memory complaint finally differed qualitatively between young and elderly people in terms of both memory processes and metacognitive beliefs. Such dissociations support a model of dynamic cognition in which intentional influences and environmental support leave awareness and consciousness emerging.MONTPELLIER-BU Lettres (341722103) / SudocSudocFranceF

Do the elders blame memory slips and controlled processes through their memory complaint ?

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Habit and Recollection in Healthy Aging, Mild Cognitive Impairment, and Alzheimer’s Disease

Objectives: This study aimed to create a new French version of the Hay and Jacoby habit-training procedure (1996; 1999) and apply it to novel populations to determine the degree to which habit and recollection were affected. Method: 36 young, 32 middle-aged, and 37 older adults participated in Experiment 1. 17 controls, 17 patients with amnestic Mild Cognitive Impairment (a-MCI), and 17 patients with Alzheimer's disease (AD) were involved in Experiment 2. Participants were assessed across a variety of demographic, neuropsychological and psychopathological variables (e.g., depressive affects, subjective experience of cognitive failures, interference sensitivity). The habit-training process-dissociation was used to explore the cognitive mechanisms underlying memory slips to separate the contribution of habit and recollection to memory performance. Results: The data show a very clear pattern of decreased recollection with age, F(2, 102) = 25.12, p < .001, η p2 = .197, and age-related neurological impairment, F(2, 48) = 39.22, p < .001, η p2 = .62, with intact use of habit-based memory. Additional evidence for the validity of the process estimates is provided by theoretically meaningful correlations between the process estimates and measures of attentional control (Stroop test: r = −0.40) and subjective memory complaint ( r = −0.45). Conclusions: Although likely not the same as familiarity, the data add to a growing literature suggesting that controlled forms of memory decline with age and in age-related neurological conditions (MCI and AD) whereas more automatic forms of memory (habit) remain intact. This research should improve understanding of memory complaints, preclinical and clinical dementia, and help target processes for rehabilitation. (PsycINFO Database Record (c) 2012 APA, all rights reserved

Memory controlled processes between the young and old: the birth of cognitive complaint?

The aim of this study is to explore cognitive complaint by investigating the influence of memory controlled processes (recollection) and metacognitive beliefs. Several methodological precautions were taken in order to control neuropsychological and psychopathological criteria, like anxiety, depression or objective memory trouble. The "habit paradigm" (Hay & Jacoby, 1999) was used to create a "memory slips" task, and to estimate the contributions of recollection and habit to performance. Besides, participants were asked to complete questionnaires in order to assess cognitive complaint (CDS) and metacognitive beliefs (MCQ). Results showed that neither cognitive complaint nor metacognitive beliefs differed significantly between young and older persons. However, statistical analysis did show cognitive dissociations in function of cognitive complaint. Finally, depressive affects, memory controlled processes and metacognitive beliefs about the controllability of thoughts appeared as good predictors of memory complaint. In spite of our study limitations, we discuss our results in terms of clinical implications

Demographic Characteristics, Motivation and Perception of Change as Determinants of Memory Compensation Self-Reports After Acquired Brain Injury

International audienceIntroduction Individuals with brain injuries experience cognitive and emotional changes that have long-lasting impacts on everyday life. In the context of rehabilitation, surveys have stressed the importance of compensating for memory disturbances to ease the impact of disorders on day-to-day autonomy. Despite extensive research on the nature of neurocognitive impairments following brain injury, few studies have looked at patients’ perceptions of these day-to-day compensations. This study examines these perceptions; in particular, what brain-injured people believe they do to compensate for memory deficiencies in everyday life. It also investigates the determinants of reported compensation strategies (age, gender, perceived stress, change awareness and motivation to succeed). Methods Eighty patients and 80 controls completed the French Memory Compensation Questionnaire, a self-report measure of everyday memory compensation. Five forms of compensation were investigated: External and Internal strategies, Reliance on social help, and investments in Time and Effort, along with two general factors: the degree of importance attached to Success (motivation) and perceptions of Change. Participants also completed measures of demographic and emotional aspects that may affect everyday compensation perceptions. Results The brain-injured group reported significantly more frequent use of memory compensation strategies than controls, with the exception of External aids. Large effects were observed for Reliance and Effort. Demographic, motivation and perception of change determinants were found to have different effects depending on the compensation strategy, and mediated the direct effect of brain injury on reported compensation. Conclusion Clinical and rehabilitation neuropsychologists often seek to have a better sense of how their patients perceive their compensatory behaviors. In practice, such an understanding is needed to help select appropriate methods and improve the long-term impact of rehabilitation programs: memory rehabilitation will fail if neuropsychologists do not deal, first and foremost, with the emotional and metacognitive issues surrounding traumatic brain injury (TBI), rather than focusing on cognitive efficiency

‘Bad news consultations’ with oncology nurses: Impact on perceived stress and patient experience

International audiencePurpose: ‘Bad News Consultations’ (BNC), conducted by nurses who are specialists in cancer, have been institutionally implemented in all French anti-cancer centres, to support the patient facing announcement-related stress. This study aimed to 1/describe the impact of the BNC on the patient's perceived stress and 2/determine the patient's benefits from the BNC.Method: This monocentric study, cross-sectional evaluation, used a mixed method, both quantitative and qualitative. During 8 months, 336 eligible participants who underwent a BNC were recruited by nurses. Perceived stress was self-assessed with a validated Visual Analogic Scale (VAS), at the beginning and at the end of the BNC. Stress resilience was self-assessed once using the CD-RISC2. Qualitative experiences were explored after the BNC, using a 25-item questionnaire. Multivariate analyses were conducted on perceived stress measures (on the VAS) to test mixed-effects models, including initial predispositions (e.g., stress resilience) and organisational constraints (e.g, interval between the medical consultation and the BNC).Results: Analyses on the perceived stress measures revealed a significant and negative effect of Time (B = −1.91; p < .001), Gender (B = 0.72; p = .03), and Resilience score (B = −0.43; p < .001), without any significant effect of the other incorporated random effects (i.e., Type of cancer/treatment) nor fixed effects (i.e., Age, Organisational constraints). Patients mostly reported having received necessary information, having their addressed emotions with empathetic responses and respect, perceived benefits in the healthcare pathway, and heard of some supportive cares.Conclusion: Perceived stress was reduced after BNCs. According to the patients, the BNCs allowed a better patient-centered communication and a better care pathway

Alexithymia impairs the cognitive control of negative material while facilitating the recall of neutral material in both younger and older adults

We investigated the moderating impact of the personality construct alexithymia on the ability of younger and older adults to control the recall of negative and neutral material. We conducted two experiments using the directed forgetting paradigm with younger and older adults. Participants studied negative (Experiment 1) or neutral (Experiment 2) words. Participants were instructed to forget the first half and remember the second half of an entire list of words. Overall, we found that alexithymia impairs the ability of both younger and older adults to cognitively control negative material (through both recall and inhibition). The “externally oriented thinking” factor of alexithymia appears to play a particularly pertinent role in terms of inhibiting negative material. Furthermore, older adults recalled fewer sought after negative items, but this was not evident in terms of inhibition. In contrast, only age (older adults) negatively impacted the recall of sought after neutral items. Interestingly, alexithymia had the opposite effect: the “difficulty in identifying emotions” factor of alexithymia was associated with an increased recall of neutral items. We discuss these results in terms of alexithymia and its impact on cognitive control

Complementary and Alternative Medicine in Patients With Breast Cancer: Exploratory Study of Social Network Forum Data

International audienceBackground: Patients and health care professionals are becoming increasingly preoccupied in complementary and alternative medicine (CAM) that can also be called nonpharmacological interventions (NPIs). In just a few years, this supportive care has gone from solutions aimed at improving the quality of life to solutions intended to reduce symptoms, supplement oncological treatments, and prevent recurrences. Digital social networks are a major vector for disseminating these practices that are not always disclosed to doctors by patients. An exploration of the content of exchanges on social networks by patients suffering from breast cancer can help to better identify the extent and diversity of these practices. Objective: This study aimed to explore the interest of patients with breast cancer in CAM from posts published in health forums and French-language social media groups. Methods: The retrospective study was based on a French database of 2 forums and 4 Facebook groups between June 3, 2006, and November 17, 2015. The extracted, anonymized, and compiled data (264,249 posts) were analyzed according to the occurrences associated with the NPI categories and NPI subcategories, their synonyms, and their related terms. Results: The results showed that patients with breast cancer use mainly physical (37.6%) and nutritional (31.3%) interventions. Herbal medicine is a subcategory that was cited frequently. However, the patients did not mention digital interventions. Conclusions: This exploratory study of the main French forums and discussion groups indicates a significant interest in CAM during and after treatments for breast cancer, with primarily physical and nutritional interventions complementing approved treatments. This study highlights the importance of accurate information (vs fake medicine), prescription and monitoring of these interventions, and the mediating role that health professionals must play in this regard