Marie-Christine Gély-Nargeot

Modeling the prevalence and incidence of Alzheimer's disease and mild cognitive impairment

A number of systems have been proposed for classifying older adults who suffer from cognitive impairment or decline but do not yet meet criteria for Alzheimers disease (AD). The classification, Mild Cognitive Impairment (MCI), has attracted much attention. It uses relatively specific diagnostic criteria and individuals who meet these criteria appear to be at substantial risk for the development of AD. However, little data is available to define the prevalence of MCI in any age group. We propose a simple mathematical model for the progression of patients from Non-Affected (NA) to MCI to AD. This first-order Markov model defines the likely prevalence of MCI at specific ages. Primary assumptions of the model include an AD prevalence of 1% at age 60 increasing to 25% at age 85 and a conversion rate from MCI to AD of 10% constant across all ages considered. We used the best available information for our model and found (1) that the MCI prevalence increased from 1% at age 60 to 42% at age 85 and (2) that the conversion rate from NA to MCI increased from 1% per year at age 60 to 11% at age 85. In conclusion, this model allows estimation of prevalence of MCI and conversion from NA to MCI based upon known prevalences of AD, conversion rates of MCI to AD, and death rates. Due to its substantial prevalence, MCI may be an important target for screening and possible intervention.

Memory for gist and detail information in Alzheimer's disease and mild cognitive impairment

Two experiments examined different forms of gist and detail memory in people with Alzheimers disease (AD) and those with amnestic mild cognitive impairment (MCI). In Experiment 1, 14 AD, 14 MCI, and 22 control participants were assessed with the Deese-Roediger-McDermott paradigm. Results indicated that false recognition of nonstudied critical lures (gist memory) was diminished in the AD compared with the MCI and control groups; the two latter cohorts performed similarly. In Experiment 2, 14 AD, 20 MCI, and 26 control participants were tested on a text memory task. Results revealed that recall of both macropropositions (gist information) and micropropositions (detail information) decreased significantly in AD and in MCI as compared with control participants. This experiment also revealed that the impairment was comparable between gist and detail memory. In summary, the results were consistent across experiments in the AD but not in the MCI participants. The discrepancy in MCI participants might be explained by differences in the degree of sensitivity of the experimental procedures and/or by the differences in the cognitive processes these procedures assessed.

Joint hypermobility syndrome: problems that require psychological intervention

Joint hypermobility syndrome (JHS), also known as Ehlers–Danlos III, is an inherited disorder of connective tissue, characterised by an exceptional increase in the joint’s mobility and the presence of musculoskeletal and other symptoms. It is a benign syndrome if compared with the other types of Ehlers–Danlos, but it can become disabling particularly because it is a significant source of pain and distress. The purpose of this work is to describe some common problems in JHS that render psychological intervention in their overall management relevant. Chronic pain, associated psychopathological factors such as anxiety, depression and somatosensory amplification, and problems arising from a lack of recognition and knowledge of the syndrome, are frequent among those affected, having a negative impact on their quality of life. We emphasise the relevance of addressing JHS from a biopsychosocial approach.

Association between psychopathological factors and joint hypermobility syndrome in a group of undergraduates from a French university.

Objective: To explore the frequency of Joint Hypermobility Syndrome (JHS) among university students and assess whether a relationship exists between this collagen condition and certain psychological variables. Method: A cross-sectional sample of 365 undergraduates at a French university was assessed with the Brightons criteria for JHS, Somatosensory Amplification Scale (SSAS), Liebowitz Social Anxiety Scale (LSAS), and Hospital Anxiety and Depression Scale (HADS). Results: 39.5% of the participants met Brightons criteria for JHS. Scores of somatosensory amplification were higher among participants with JHS (t = −2.98; p = 0.03) independent of gender. Female participants with JHS had higher scores in depression (t = −2.01; p = 0.04) and general anxiety (t = −2.35; p = 0.01) than women without JHS. The percentage of males with a medium/high level of social anxiety was greater among participants with JHS (78.6% vs. 41.7%; χ2 = 6.18; p = 0.01). Logistic regression demonstrated that male sex and low level of somatosensory amplification are variables contrary to the presence of JHS. Conclusion: JHS is a frequent condition among young people evaluated. JHS is associated with psychological distress and higher levels of somatosensory amplification.

A further evaluation of decision-making under risk and under ambiguity in schizophrenia.

Abnormal decision-making has been described as a key-concept to understand some behavioral disturbances in schizophrenia. However, whether schizophrenia patients display impairments in profitable decision-making on experimental designs is still controversial (1) to assess performance on decision-making paradigms under ambiguity and under risk conditions in a large sample of schizophrenia patients and (2) to study the impact of clinical variables on decision-making performance in schizophrenia. The Iowa gambling task (IGT) and the game of dice task (GDT) were administered to assess, respectively, decision-making under ambiguity and under risk in 63 schizophrenia patients and 67 healthy controls. In addition, clinical variables (e.g., schizophrenic symptoms, self-reported depression, and impulsivity) were evaluated using appropriate questionnaires the same day. Pharmacological treatments were reported. Schizophrenia patients had impaired performances on both IGT and GDT tasks. No correlation between the decision-making tasks performance and clinical variables was found. Lower gains on the GDT were associated with executive dysfunctioning in schizophrenia. These findings give evidence that schizophrenia patients display impairments in both decision-making under ambiguity and under risk.

Early maladaptive schemas predict positive symptomatology in schizophrenia: A cross-sectional study

Recent literature has shown the role of social factors, such as childhood negative experiences and attachment styles, in the genesis of psychotic symptoms. So far, despite this association with childhood negative experiences and a wide range of psychiatric disorders, no study has yet attempted to assess early maladaptive schemas (EMSs) in patients with schizophrenia as primary diagnosis. A sample of 48 patients diagnosed with schizophrenia and 44 control participants answered the schema questionnaire short forms French validation, and were assessed with the positive and negative syndrome scale as well as a scale of depression symptomatology. Results showed that, after controlling for depression, patients with schizophrenia achieved higher scores than control subjects on six EMSs. The EMSs were associated with positive, but not negative, symptomatology. After controlling for depression, only the Mistrust/Abuse schema was a significant predictor of positive symptoms accounting for a small portion (12.4%) of the variance. The results highlight the importance of focusing not only on the schizophrenic symptoms but also on the person and his or her subjective development of self. Therefore, these results suggest that Youngs schema theory may be applied to schizophrenic patients.

Self-defining memories during exposure to music in Alzheimer's disease

BACKGROUND Research suggests that exposure to music may enhance autobiographical recall in Alzheimers Disease (AD) patients. This study investigated whether exposure to music could enhance the production of self-defining memories, that is, memories that contribute to self-discovery, self-understanding, and identity in AD patients. METHODS Twenty-two mild-stage AD patients and 24 healthy controls were asked to produce autobiographical memories in silence, while listening to researcher-chosen music, and to their own-chosen music. RESULTS AD patients showed better autobiographical recall when listening to their own-chosen music than to researcher-chosen music or than in silence. More precisely, they produced more self-defining memories during exposure to their own-chosen music than to researcher-chosen music or during silence. Additionally, AD patients produced more self-defining memories than autobiographical episodes or personal-semantics during exposure to their own-chosen music. This pattern contrasted with the poor production of self-defining memories during silence or during exposure to researcher-chosen music. Healthy controls did not seem to enjoy the same autobiographical benefits nor the same self-defining memory enhancement in the self-chosen music condition. CONCLUSIONS Poor production of self-defining memories, as observed in AD, may somehow be alleviated by exposure to self-chosen music.

Destination memory and cognitive theory of mind in normal ageing

Destination memory is the ability to remember the destination to which a piece of information has been addressed (e.g., “Did I tell you about the promotion?”). This ability is found to be impaired in normal ageing. Our work aimed to link this deterioration to the decline in theory of mind. Forty younger adults (M age = 23.13 years, SD = 4.00) and 36 older adults (M age = 69.53 years, SD = 8.93) performed a destination memory task. They also performed the False-belief test addressing cognitive theory of mind and the Reading the mind in the eyes test addressing affective theory of mind. Results showed significant deterioration in destination memory, cognitive theory of mind and affective theory of mind in the older adults. The older adults’ performance on destination memory was significantly correlated with and predicted by their performance on cognitive theory of mind. Difficulties in the ability to interpret and predict others’ mental states are related to destination memory decline in older adults.

Destination Memory and Cognitive Theory of Mind in Alzheimer's Disease

Destination memory, or the ability to remember the destination to whom a piece of information was addressed, is found to be compromised in Alzheimers disease (AD). Our paper investigated the relationship between destination memory and theory of mind in AD since both destination memory and theory of mind are social abilities that require processing attributes of interlocutors. Mild AD participants and controls were administered tasks tapping destination memory, affective theory of mind, and 1st and 2nd order cognitive theory of mind. Relative to controls, AD participants showed compromise in destination memory and 2nd order cognitive theory of mind, but preserved performance on affective and 1st order cognitive theory of mind. Significant correlations were observed between destination memory, and 1st and 2nd order cognitive theory of mind in AD participants and controls. By demonstrating a relationship between compromises in 2nd order theory of mind and in destination memory, our work highlights links between social cognition and memory functioning in AD.

Apathy and emotion-based decision-making in amnesic mild cognitive impairment and Alzheimer's disease.

Background. Apathy and reduced emotion-based decision-making are two behavioral modifications independently described in Alzheimers disease (AD) and amnestic mild cognitive impairment (aMCI). Objectives. The aims of this study were to investigate decision-making based on emotional feedback processing in AD and aMCI and to study the impact of reduced decision-making performances on apathy. Methods. We recruited 20 patients with AD, 20 participants with aMCI, and 20 healthy controls. All participants completed the Lille apathy rating scale (LARS) and the Iowa gambling task (IGT). Results. Both aMCI and AD participants had reduced performances on the IGT and were more apathetic compared to controls without any difference between aMCI and AD groups. For the entire sample, LARS initiation dimension was related to IGT disadvantageous decision-making profile. Conclusions. We provide the first study showing that both aMCI and AD individuals make less profitable decisions than controls, whereas aMCI and AD did not differ. Disadvantageous decision-making profile on the IGT was associated with higher level of apathy on the action initiation dimension. The role of an abnormal IGT performance as a risk factor for the development of apathy needs to be investigated in other clinical populations and in normal aging.