J ai modifié mon Empathie (Expertise neuropsychologique (Attention et Emotion) du cas NG)

Dans le champ de la psychopathologie, de nombreuses études s intéressent aux complications psychiatriques observées dans l épilepsie partielle pharmaco-résistante temporale. On estime à 31% la prévalence de ces troubles psychiatriques au décours d une lobectomie temporale antérieure. La plupart du temps, il est rapporté des troubles de l humeur et des troubles anxieux. Récemment, quelques études se sont intéressées à l aspect neuropsychologique comportemental dans l épilepsie temporale notamment la reconnaissance des expressions faciales, la cognition sociale et plus particulièrement la théorie de l esprit. Cependant, aucune étude n a porté sur l évaluation de l empathie. Le fil directeur de ce travail de thèse a reposé sur l écoute des plaintes d une patiente (NG) épileptique ayant subi une amygdalo-hippocampectomie droite. Très rapidement après la chirurgie elle a ressenti des modifications de ses émotions et surtout de son empathie. Cette plainte reste présente et inchangée après 13 ans de suivi post-opératoire. Pour expertiser de cette situation singulière, la patiente a réalisé outre un bilan neuropsychologique extensif, des épreuves classiques de psychopathologie cognitive, des épreuves adaptées de la littérature ou des épreuves construites au fil de la recherche clinique guidées par les données recueillies. D autre part, nous nous sommes intéressés à l influence des émotions sur l attention. Ainsi, nous avons étudié la capture attentionnelle de NG pour des stimuli émotionnels. Dans notre étude, nous avons confirmé que les performances de NG dans les tâches d empathie et de théorie de l esprit émotionnelle sont excellentes. De plus nous avons démontré une capture attentionnelle globale pour NG envers les stimuli émotionnels. En évaluant la pertinence de ces stimuli (mots et images), nous avons rapporté un effet majeur de celle-ci sur les ressources attentionnelles de la patiente. Notre travail est le premier, en l état actuel de la littérature, à décrire une amplification spectaculaire de l empathie après une amygdalo-hippocampectomie droite. Cette patiente présente une capacité plus développée à décoder les états mentaux d autrui, notamment leurs émotions. Nous rapprochons l amplification d empathie pour NG avec une dysconnexion fronto-amygdalienne droite. Nous démontrons également que cette révélation d un nouveau comportement peut relever d un biais de capture attentionnelle pour les stimuli émotionnels, traduisant un traitement perceptif différent, plus opérationnel ou sélectif.ST ETIENNE-BU Médecine (422182102) / SudocSudocFranceF

Cognitive Impairment in Secondary Progressive Multiple Sclerosis: Effect of Disease Duration, Age, and Progressive Phenotype

International audienceBackground: Cognitive deficits are common in multiple sclerosis (MS) and affect patients at all stages of the disease, regardless of phenotype. Aims: This literature review focuses the cognitive deficits observed in secondary progressive MS (SPMS). It is mainly based on studies that compared the frequency and main characteristics of cognitive deficits in SPMS with other phenotypes. Methods: A bibliographic search was carried out using the PubMed database with the following keywords: multiple sclerosis, secondary-progressive, cognition. Results: Thirteen studies were initially selected that were published in English, reporting the neuropsychological data of a sample of at least 30 patients with SPMS, comparing them with patients with other phenotypes. Studies suggest that there is an association between the duration of the disease and the frequency and extent of the cognitive disorders. Studies also showed that the SP form is associated with an increased frequency of cognitive impairment and with an increased severity as compared to relapsing-remitting MS (RRMS). Compared to RRMS, progressive forms of MS are associated with more severe impairment in certain cognitive areas, such as episodic verbal memory, information processing speed, working memory, or verbal fluency. Two studies showed that cognitive performances decline overtime in SPMS. Conclusion: Cognitive disorders are more frequent and more severe in the SP form than in relapsing course of MS. The profile of cognitive impairment encountered in the SP form also appears to be different from those found in the other phenotypes

Can maintaining cognitive function at 65 years old predict successful ageing 6 years later? The PROOF study

Methods: nine hundred and seventy-six questionnaires were sent by mail to a sample of healthy and voluntary French pensioners. Successful ageing was defined through health status and well-being. Cognitive abilities had been assessed 6 years earlier according to an objective method (Free and Cued Selective Recall Reminding Test (FCSRT), the Benton visual retention test and the similarities subtest of the Wechsler Adult Intelligence Scale-Revised) and a subjective one (Goldberg's anxiety scale, Mac Nair's scale and a Visual Analogue Scale to evaluate memory abilities change in the last 5 years). Results: six hundred and eighty-six questionnaires could be analysed. The mean age was 72.9 +/- 1.2 years old with 59% of women and 99% lived at home. Well-being was negatively correlated with the FCSRT (r = -0.08, P = 0.0318) but positively related with the Benton (r = 0.09, P = 0.0125) and the similarities tests (r = 0.09, P = 0.0118). There is a negative correlation between anxious and cognitive complaints measured at baseline, and successful ageing indicators 6 years later. Conclusion: preservation of cognitive abilities at the age of retirement can predict a successful ageing 6 years later. ClinicalTrials.gov Identifier: NCT00759304

A clinical screening tool for objective and subjective cognitive disorders in multiple sclerosis

International audienceBACKGROUND: Cognitive dysfunction is common in multiple sclerosis (MS). Deficits can affect attention, concentration, planning, and memory. They can have severe functional consequences in many domains. Cognitive complaints are frequently associated with other confounding factors (fatigue, anxiety, depression, or treatment side effects). In most cases, cognitive assessment is proposed after a spontaneous complaint, but determining the extent of discomfort perceived by the patient, the influence of coexisting factors, or the optimal timing for a more complete neuropsychological assessment is difficult. OBJECTIVE: The objective of this work was to evaluate the feasibility and relevance of a fast global assessment of both objective and subjective cognitive dysfunction in MS. METHODS: MS patients underwent a brief cognitive assessment including 7 visual analogue scales (VASs) asking about the patient's subjective level of discomfort in various domains, a memory test (Barbizet's lion story), a commonly used test of information processing speed (Symbol Digit Modalities Test [SDMT]) and self-reporting questionnaires for fatigue and mood (Fatigue Severity Scale [FSS] and Hospital Anxiety and Depression Scale [HADS]). Spearman correlation coefficients among scores were estimated. RESULTS: The mean age of the 73 patients included was 48.3 (SD 11.1) years; 78% were females and 52.8% had the remittent-recurrent MS form, 8.3% the primary progressive form, and 38.9% the secondary progressive form. In less than 20min, this brief cognitive assessment was able to identify symptoms and quantify discomfort level. Symptoms of fatigue and anxiety frequently coexisted with cognitive complaints. We found modest correlations between scores on the VAS fatigue and the FSS and between scores on the VAS mood and the HADS. Analytical evaluation revealed that most patients had similar SDMT and recall profiles; however, a small proportion showed a dissociation between these 2 tests, which validated the inclusion of both tests in the assessment. Accounting for coexisting factors (e.g., anxiety and fatigue) and their functional repercussions is essential for prioritizing these problems within the context of multidisciplinary patient treatment. CONCLUSION: Considering the possible multifactorial character of cognitive dysfunction in MS, it is essential to ask patients about their experiences and to take into account cognitive complaints in the follow-up of patients. The assessment tool we propose is simple and easy to use in a clinical setting and provides the information necessary for requesting (or not) a more complete neuropsychological assessment

French adaptation of the vascular cognitive impairment harmonization standards: the GRECOG-VASC study

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TARDBP mutations in motoneuron disease with frontotemporal lobar degeneration.

International audienceTDP-43 (TAR-DNA binding protein) aggregates in neuronal inclusions in motoneuron disease (MND), as well as in frontotemporal lobar degeneration (FTLD) and FTLD associated with MND (FTLD-MND). Mutations in TARDBP gene, coding for TDP-43, were found in patients with pure MND. We now describe TARDBP mutations in two patients with FTLD-MND, presenting with a behavioral variant of FTLD and semantic dementia, suggesting that TDP-43 may also have a direct pathogenic role in FTLD disorders

Cerebrospinal Fluid Collection Tubes: a critical issue for Alzheimer Disease diagnosis

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Risk of Alzheimer’s Disease biological misdiagnosis linked to cerebrospinal collection tubes

Tau proteins and amyloid-β (Aβ) peptides are the current recognized cerebrospinal fluid (CSF) biomarkers used as an aid in the diagnosis of Alzheimer's disease (AD). However, there is no consensus on their clinical use due to non-qualified cut-off values, probably related to the observed high pre-analytical and analytical variability. Standardized pre-analytical protocols have therefore been proposed. Importantly, these recommend the use of polypropylene collection/sampling tubes while, to date, no broad comparison of these types of tubes has been conducted. In this study, we first compared, as part of a real clinical workflow, the impact of four different collection tubes on the CSF concentration of Aβ peptides (Aβ42, Aβ40) and total (hTau) and phosphorylated (P-Tau181P) tau proteins measured using routine ELISA kits. We then extended this study to 11 polypropylene tubes used by different clinical laboratories, and investigated their plastic polymer composition using differential scanning calorimetry and Fourier Transformed Infrared spectroscopy. Significant concentration variations linked solely to the use of different types of tubes were observed. This was particularly marked for Aβ peptides, with >50% disparity occurring in less than five minutes. Polymer composition analysis revealed that most polypropylene tubes were in fact copolymers with at least polyethylene. There was no clear correlation between tube composition and pre-analytical behavior. Our results show that the use of polypropylene tubes does not guarantee satisfactory pre-analytical behavior. They also point to collection/sampling tubes being a major pre-analytical source of variability that could impact the significance of AD biological diagnosis