Christine Moroni

Mood and anxiety disorders in systemic sclerosis patients

OBJECTIVE To assess the prevalence of mood and anxiety disorders in systemic sclerosis (SSc) patients and the association of these disorders with clinical features. METHODS Between May 2002 and May 2004, 100 SSc patients fulfilling the American Rheumatism Association and/or Leroy & Medsger criteria were recruited: 51 were from a SSc patient association meeting, and 49 were hospitalized in an internal medicine department and recruited consecutively. Mood and anxiety disorders were assessed by use of a structured clinical interview [the Mini International Neuropsychiatric Interview (MINI)] performed by a psychiatrist and a self-reporting questionnaire [the Hospital Anxiety and Depression Scale (HADS)]. On the same day, psychiatric treatment and clinical features were recorded by a physician. RESULTS As assessed by the MINI, 19% [95% confidence interval 12-28%] of all SSc patients were currently experiencing a major depressive episode (MDE), 56% [46-65%] had a lifetime history of MDE and 14% [8-22%] had current dysthymia. Current MDE was more prevalent among hospitalized patients than among other patients (28% versus 10%, p=0.02). Specific anxiety disorders were diagnosed in 37 [28-47] patients. Less than 50% of the patients with mood disorders received psychiatric treatment. Patients with or without current depression did not differ in clinical symptoms of SSc, except for digestive symptoms. CONCLUSION The current and lifetime prevalence of major depression and anxiety disorders is high in SSc patients, especially during hospitalization. However, only half of such patients receive adequate psychiatric treatment. Therefore, a better assessment of psychiatric disorders in SSc patients is needed.

Cognitive function and 99mTc-ECD brain SPECT are significantly correlated in patients with primary Sjögren syndrome: a case–control study

Objectives: To assess subclinical central nervous system (CNS) involvement in primary Sjögren syndrome (pSS), by comparing standard brain MRI, in-depth neuropsychological testing and 99mTc-ECD brain single-photon emission computed tomography (SPECT) of patients with pSS with matched controls. Methods: 10 women (<55 years old), with pSS defined using European–American criteria, presence of anti-SSA and/or anti-SSB antibodies and no history of neurological involvement were prospectively investigated, and compared with 10 age- and sex-matched controls. All subjects underwent, within 1 month, brain MRI, neuropsychological testing, including overall evaluation and focal cognitive function assessment, and 99mTc-ECD brain SPECT. Results: 99mTc-ECD brain SPECT abnormalities were significantly more common in patients with pSS (10/10) than controls (2/10; p<0.05). Cognitive dysfunctions, mainly expressed as executive and visuospatial disorders, were also significantly more common in patients with pSS (8/10) than controls (0/10; p<0.01). Notably, between-group comparisons enabled a significant correlation to be established between neuropsychological assessment and 99mTc-ECD brain SPECT abnormalities in patients with pSS (rs = 0.49, p<0.01). MRI abnormalities in patients and controls did not differ significantly. Conclusions: Neuropsychological testing and 99mTc-ECD brain SPECT seem to be the most sensitive tools to detect subclinical CNS dysfunction in pSS. The strong correlation between cortical hypoperfusion in 99mTc-ECD brain SPECT and cognitive dysfunction suggests an organic aetiology of CNS dysfunction in pSS. These data should be confirmed in a larger study.

Neglected attention in apparent spatial compression

Halligan and Marshall [Cortex 27 (1991) 623] devised a new test to evaluate the hypothesis that in visual neglect, left space is systematically compressed rightwards. In the critical condition of the original study, rows of horizontally arranged numbers with a target arrow pointing to one of them from the opposite margin of the display were presented. When asked to verbally identify the number indicated by the arrow, a right brain-damaged patient with left neglect and hemianopia often indicated a number to the right of the target. The more the target was located on the left, the greater the response shift rightward, as if rightward compression were linearly proportional to the co-ordinates of Euclidian space. However, a possible alternative account could be that the patients attention was attracted by the numbers located to the right of the target digit, thus biasing her responses toward numbers on the right. To explore this hypothesis, we asked normal participants and patients with right hemisphere lesions, with and without neglect or hemianopia, to mark on the margin of a sheet the approximate location indicated by an arrow situated on the opposite margin. In three different conditions, the arrow indicated either one of several numbers or lines in a row, or a blank location on the sheet margin. Only patients with left neglect, and especially those with associated hemianopia, deviated rightward, and then crucially only on those conditions where visible targets were present, consistent with the attentional bias account.

To what extent does destination recall induce episodic reliving? Evidence from Alzheimer's disease.

We compared destination memory to source memory in patients with Alzheimer’s disease (AD), as the latter type of memory is believed to be severely deteriorated in AD. Control participants and AD patients were tested on two conditions, both of which had a study phase and a recognition phase. In the study phase of the first condition, participants had to tell a set of facts to the faces of a set of celebrities (destination memory). In the study phase of the second condition, they had to receive a different set of facts from a different set of celebrity faces (source memory). During the recognition phase, participants had to indicate, for destination memory, whether they had previously told a given fact to a given face (yes) or not (no) and, for source memory, whether they had previously received a given fact from a given face (yes) or not (no). In both conditions, they were asked to choose between “remember” or “know” options when answering “yes.” AD patients showed reliable difficulties in destination recall, accompanied by a significant decrease in the number of “remember” responses they gave. AD-related destination memory decline may be attributed to the perturbation of episodic memory and its autonoetic reliving. The potential neural bases of this decline are discussed in terms of hippocampal failures.

Prospective and retrospective time perception are related to mental time travel: evidence from Alzheimer's disease.

Unlike prospective time perception paradigms, in which participants are aware that they have to estimate forthcoming time, little is known about retrospective time perception in normal aging and Alzheimers disease (AD). Our paper addresses this shortcoming by comparing prospective and retrospective time estimation in younger adults, older adults, and AD patients. In four prospective tasks (lasting 30s, 60s, 90s, or 120s) participants were asked to read a series of numbers and to provide a verbal estimation of the reading time. In four other retrospective tasks, they were not informed about time judgment until they were asked to provide a verbal estimation of four elapsed time intervals (lasting 30s, 60s, 90s, or 120s). AD participants gave shorter verbal time estimations than older adults and younger participants did, suggesting that time is perceived to pass quickly in these patients. For all participants, the duration of the retrospective tasks was underestimated as compared to the prospective tasks and both estimations were shorter than the real time interval. Prospective time estimation was further correlated with mental time travel, as measured with the Remember/Know paradigm. Mental time travel was even higher correlated with retrospective time estimation. Our findings shed light on the relationship between time perception and the ability to mentally project oneself into time, two skills contributing to human memory functioning. Finally, time perception deficits, as observed in AD patients, can be interpreted in terms of dramatic changes occurring in frontal lobes and hippocampus.

Victoria Stroop Test: Normative Data in a Sample Group of Older People and the Study of Their Clinical Applications in the Assessment of Inhibition in Alzheimer's Disease

The Stroop Color-Word Test-Victoria version (VST) is a measure of executive function commonly used in neuropsychological evaluation. Because of its short administration time, the VST seems particularly appropriate for use in geriatric populations and with those suffering from dementia and who are prone to fatigue during neuropsychological examination. In this study, we examine the influence of demographic characteristics on VST score and present descriptive data for a sample of 244 elderly French speakers (50-94 years of age). Normative data corrected for age and education are provided for clinical use. Furthermore, by comparing the VST performance of patients with the Alzheimer-type dementia to that of 40 matched healthy controls, we provide clinical evidence suggesting that the VST has a clinical utility in the assessment of inhibition in AD.

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

Small artery infarction, which is particularly prevalent among Asians (1), carries a lower risk of recurrent stroke at one-month compared with other stroke subtypes, but long-term findings are inconsistent (2,3). Data on subsequent myocardial infarction risk after small artery stroke are limited. We compared the incidence of vascular events following ischemic stroke due to small artery disease vs. other etiologies among prospectively recruited Asian patients admitted to the Singapore General Hospital from 2005 to 2007. Telephone follow up at a median of 30 months (IQR 24–34) masked to clinical information was obtained for 89% of the cohort. Among the 731 patients with known stroke etiology, 49% had small artery infarction, 38% had large artery infarction, 12% had cardioembolic, and 1% had other etiology. Figure 1 shows the cumulative incidence of subsequent vascular events. Using Cox regression adjusted for age, gender, hypertension, diabetes, hyperlipidemia, smoking, and atrial fibrillation, small artery infarction was associated with a lower incidence of recurrent stroke [hazard ratio (HR) 0·62; P = 0·047], myocardial infarction (HR 0·45; P = 0·031), vascular death (HR 0·18; P = 0·002), and composite vascular events (HR 0·59, P = 0·007) compared with nonsmall artery stroke. The lower risk of subsequent vascular events following small artery infarction may be explained by a differing underlying pathology from large artery and Correspondence: Deidre Anne De Silva*, Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, 169608 Singapore. E-mail: gnrdsd@sgh.com.sg

Processus d’inhibition : quelle est leur évolution après 50 ans ?

Increased difficulty with inhibition responses has been reported in aging. We used a French adaptation of the Victoria Stroop Test to assess the evolution of inhibitory processes in 107 healthy participants aged from 50 year old to 95 year old. A mild influence of age was shown on the efficiency of the inhibitory processes, and an important heterogeneity of performances for participants over the age of 81. Decline of the inhibitory processes was observed mainly when the task required a strong inhibitory process, and when an analysis of the speed to perform each task and the produced errors was conjointly performed.

Action and noun fluency testing to distinguish between Alzheimer's disease and dementia with Lewy bodies

The objective of the present study was to establish whether performance in an action fluency task is of value in the differential diagnosis of Alzheimers disease (AD) and dementia with Lewy bodies (DLB). After collecting normative data on performance in an action fluency task and a conventional animal fluency task in a cohort of French-speaking healthy controls, we assessed AD and DLB patients. Only the action fluency score differed significantly between the two demented groups, with DLB patients performing worse than AD patients. However, a composite action and animal fluency score was found to be more effective for discriminating between these two groups.

Rapid categorization of faces and objects in a patient with impaired object recognition.

We tested rapid-categorization in a patient who was impaired in face and object recognition. Photographs of natural scenes were displayed for 100 ms. Participants had to press a key when they saw an animal among various objects as distractors or human faces among animal faces as distractors. Though the patient was impaired at figure/ground segregation, recognized very few objects and faces, she categorized animals and faces with a performance ranging between 70 and 86% correct. Displaying pictures in isolation did not improve performance. The results suggest that rapid categorization can be accomplished on the basis of coarse information without overt recognition.