Etude Clinique des niveaux de perturbation de la metacognition, de la cognition sociale et du contrôle exécutif dans la pathologie frontale

Recent and convergent studies in neuropsychology have suggested the importance of frontal regions to the integrity of a number of functions such as metamemory capacities, executive functions, and social skills (Theory of Mind : ToM). In this original work, following Stuss et Anderson (2004), we assume a link between disturbances of these functions. We proposed to 16 frontal patients and 20 matched healthy subjects a protocol designed to test metamemory, ToM and executive functions in order to analyze the relations between disturbances of self-awareness (metamemory) and awareness of others (ToM), and cognitive control (executive functions). Our results confirm the importance of frontal lobes on these capacities. No correlation was found between measures of metamemory, measures of ToM and executive scores. The observation of individual profiles emphasizes the existence of dissociations between self awareness and consciousness of the others, and between these two forms of metacognitive control and the executive functioning. These results confirm the importance to engage more studies combining aspects of ToM, metacognition and executive control, to better understand the organization and architecture of the functions supported by frontal lobe

Contraception and screening for cervical and breast cancer in neuromuscular disease: A retrospective study of 50 patients monitored at a clinical reference centre

AbstractObjectiveTo analyse contraceptive methods and the extent of screening for breast and cervical cancer in women with neuromuscular disease, compare these results with data and guidelines for the general population and determine the environmental and attitudinal barriers encountered.Patients and methodsA retrospective, descriptive study in a population of female neuromuscular disease patients (aged 20 to 74) monitored at a clinical reference centre.ResultsComplete datasets were available for 49 patients. Seventy percent used contraception (hormonal contraception in most cases). Sixty-eight percent had undergone screening for cervical cancer at some time in the previous 3 years and 100% of the patients over 50 had undergone a mammography. Architectural accessibility and practical problems were the most common barriers to care and were more frequently encountered by wheelchair-bound, ventilated patients.ConclusionsIn general, the patients had good access to contraceptive care and cervical and breast cancer screening. However, specific measures may be useful for the most severely disabled patients

Bilingualism and adult differences in inhibitory mechanisms: Evidence from a bilingual stroop task

The present investigation examined the functioning of inhibitory mechanisms in younger and older bilinguals using a bilingual version of the Stroop test. The study predicted different patterns of age related decline in inhibitory mechanisms (inter- and intralingual interference) in bilinguals depending on their level of proficiency. Consistent with expectations, older bilinguals were slower when they responded in their non-dominant language. Furthermore, older unbalanced bilinguals showed greater interlingual interference when they responded with their second language to visual stimuli written in their dominant language. Balanced bilinguals showed equivalent interference effects between all conditions. These findings suggest that manipulating two languages may enhance the efficiency of inhibitory mechanisms

Théorie de l'esprit et lobe frontal : contributions de la neuropsychologie clinique

This study has invistigated theory of mind (TOM) in frontal patients. The main propose of this work was to add clinical results to the numerous functional neuroimaging and psychopathological studies in order to contribute to establish neural correlates of theory of mind and its relations with the frontal lobes. In this way, we conducted several works in various neurological populations (severe brain injured patients, patients with Huntington disease and patients with frontal citcumscribed lesions) in order to analyse the impact of the frontal lesions on this ability wich plays a crucial role in social adaptaion. In the three studies proposed, the results suggest difficulties in the understanding of mental states of others for all experimental populations compared with controls. on the other hand, dissociations appear concerning performances within the frontal focal group, some patients performing as well as the various control samples. The analysis of the excutive variables does not makes it possible to explain these differences. The lesion analysis we carried out shows a link between lesions of the orbital areas and lateral prefrontal aspects (supraventricular and paraventricular areas) and weak performances in task of TOM from Baron-Cohen and al. (2001). The analysis carried out for the task of attribution of intention to othes (Sarfati et al., 1997) emphasize a more right median implication. Nevertheless, the analysis of laterality does not make it possible to conclure as for a pejorative effect pf the roght lesions on comptences in TOM.Ce travail a étudié les compétences en Théorie de l'esprit (TDE) de patients présentent un dysfonctionnement frontal. L'objectif ici était de venir confronter les résultats des nombreuses études réalisées en psychopathologie ou en imagerie cérébrale, chez le sujet sain, à la réalité clinique du patient cérébrolésé. Dans cette perspective, nous avons conduit plusieurs travaux auprès de différentes populations neurologiques (patients traumatisés crâniens graves, malades de Huntungton, patients porteurs de lésions frontales focales) afin d'analyser l'impact des lésions frontales sur cette compétence socio-cognitive que l'on sait jouer un rôle primordial dans l'adaptation sociale. Dans les trois études proposées, les résultats ont objectivé des difficultés dans la compréhension des états mentaux d'autrui pour toutes les populations étudiées. Par contres, il est apparu des dissociations de performances au sein du groupe de patients frontaux focaux, certains malades se montrant aussi performants que les sujets constituants les différentes populations contrôles. L'analyse des variables exécutives n'a pas permis d'expliquer ces différences. L'analyse lésionnelle a montré une relation entre des lésions des régions orbitaires et latérales (paraventriculaire et supraventriculaire) et de faibles performances en tâche de TDE pour le test de pathographies des regards (Baron-Cohen et al., 2001). L'analyse effectuée pour la tâche d'attribution d'intention à autrui (Sarfati et al., 1997) a souligné une implication des structures médianes droites. Les analyses de la latéralité lésionnelle n'ont cependant pas permis de conclure quant à un effet péjoratif des lésions droites sur les compétences droites en TDE