Michèle Montreuil

Social cognition impairments in relapsing-remitting multiple sclerosis.

Theory of Mind (ToM) is the ability to attribute independent mental states to self and others to explain and predict behavior. Impairment of ToM is well established in developmental pathologies. In neurological populations, investigation of ToM is still rare but data suggest that ToM impairment could contribute to behavioral and social disturbances. In addition to neurological signs, multiple sclerosis (MS) presents with disorders of cognition and behavior directly related to brain damage. The aim of this study was to assess ToM abilities and recognition of facial emotional expression in adults with MS. We compared 64 patients with relapsing MS and 30 matched healthy controls on three levels of ToM tasks, a facial emotion recognition task, and a neuropsychological assessment. MS patients performed significantly worse than controls in emotion recognition and all ToM tasks (p < .02). These deficits were not correlated with demographic variables or neuropsychological test performance. These findings underscore the importance of assessing ToM and facial recognition in MS, as dysfunction in these areas may impact upon social interaction and, thus, impair quality of life for both patients with MS and their families.

Community integration after severe traumatic brain injury in adults.

PURPOSE OF REVIEW Despite being the main cause of death and disability in young adults, traumatic brain injury (TBI) is a rather neglected epidemic. Community integration of persons with TBI was, until recently, insufficiently informed by clinical research. RECENT FINDINGS To bridge the gap between rehabilitation and community re-entry, the first task is to assess the person, using TBI-specific outcome measures. The second task is to provide re-entry programs, the effectiveness of which is assessed by those measures, using well designed studies. There are very few such studies. However, there are some effective comprehensive programs and others which are specifically targeted dealing mainly with return to work, behavior, and family issues. The complex psychological and environmental components of the disability require individualized and often long-term care. SUMMARY For persons with severe TBI trying to achieve the best possible community integration a new semiology is required, not just limited to medical care, but also involving social and psychological care that is tailored to the needs of each individual and family, living within his/her environment. Currently, only a minority benefit from well validated programs.

Cognitive outcomes and health-related quality of life in adults two decades after the arterial switch operation for transposition of the great arteries

Objective: The study objective was to evaluate the cognitive and psychosocial outcomes of young adults who underwent an arterial switch operation for transposition of the great arteries. Methods: Sixty‐seven adults with transposition of the great arteries (aged 22.9 ± 3.3 years) and 43 healthy subjects matched in age, gender, and educational level participated. Global cognitive functioning, psychologic state, and health‐related quality of life were evaluated using validated tools. We analyzed patient‐related and procedure‐related risk factors associated with cognitive and psychosocial outcomes. Results: Some 69% of patients had an intelligence quotient greater than 85 (normal range, 85‐115). Mean full‐scale, verbal, and performance intelligence quotients were lower in patients (94.9 ± 15.3, 96.8 ± 16.2, 93.7 ± 14.6, respectively) than in healthy subjects (103.4 ± 12.3, P = .003; 102.5 ± 11.5, P = .033; 103.8 ± 14.3, P < .001, respectively). Cognitive difficulties (intelligence quotient ≤−1 standard deviation) and impairments (intelligence quotient ≤−2 standard deviations) were more frequent in patients than in the general population (31% vs 16%, P = .001; 6% vs 2%, P = .030). Patients with cognitive difficulties had lower educational level (P < .001) and more grade retention at school (P = .007). Patients reported an overall satisfactory health‐related quality of life; however, those with cognitive or psychologic difficulties reported poorer quality of life. Predictors of worse outcomes included lower parental socioeconomic and educational status, older age at surgery, and longer hospitalization stay. Conclusions: Despite satisfactory outcomes in most adults with transposition of the great arteries, a substantial proportion has cognitive or psychologic difficulties that may reduce their academic success and quality of life. Further studies are needed to better understand the long‐term outcome of this population to provide prevention, surveillance, and care strategies.

Performance of a French sample on the French translation of the BNI Screen for Higher Cerebral Functions

Abstract Objective: To obtain normative data using a French translation of the BNI Screen for Higher Cerebral Functions (BNIS) administered to French-speaking individuals. Methods: Recruitment and administration of the BNIS to a convenience sample of 167 French-speaking individuals between the ages of 15–84 years. Results: Mean BNIS total score for a French sample was within 1 point of what was observed in the original standardization study using 200 English-speaking controls. Age and education correlated significantly with BNIS scores in a manner reported by other studies. Conclusion: The French translation of the BNIS appears to be a reliable method of assessing higher cerebral functioning in French-speaking individuals.

Screening for cognitive and affective dysfunction in patients suspected of mild cognitive impairment

Disturbances of affect expression and perception, as well as accuracy of predicting memory difficulties, have been reported in various brain dysfunctional groups. Screening tests of higher cerebral functions seldom sample these dimensions. The goal of this study was to determine if patients with mild cognitive impairment (MCI) of the amnestic type would demonstrate impairments in these domains, as well as show expected memory deficits.

Anxiety, emotional processing and depression in people with multiple sclerosis

BackgroundDespite the high comorbidity of anxiety and depression in people with multiple sclerosis (MS), little is known about their inter-relationships. Both involve emotional perturbations and the way in which emotions are processed is likely central to both. The aim of the current study was to explore relationships between the domains of mood, emotional processing and coping and to analyse how anxiety affects coping, emotional processing, emotional balance and depression in people with MS.MethodsA cross-sectional questionnaire study involving 189 people with MS with a confirmed diagnosis of MS recruited from three French hospitals. Study participants completed a battery of questionnaires encompassing the following domains: i. anxiety and depression (Hospital Anxiety and Depression Scale (HADS)); ii. emotional processing (Emotional Processing Scale (EPS-25)); iii. positive and negative emotions (Positive and Negative Emotionality Scale (EPN-31)); iv. alexithymia (Bermond-Vorst Alexithymia Questionnaire) and v. coping (Coping with Health Injuries and Problems-Neuro (CHIP-Neuro) questionnaire. Relationships between these domains were explored using path analysis.ResultsAnxiety was a strong predictor of depression, in both a direct and indirect way, and our model explained 48% of the variance of depression. Gender and functional status (measured by the Expanded Disability Status Scale) played a modest role. Non-depressed people with MS reported high levels of negative emotions and low levels of positive emotions. Anxiety also had an indirect impact on depression via one of the subscales of the Emotional Processing Scale (“Unregulated Emotion”) and via negative emotions (EPN-31).ConclusionsThis research confirms that anxiety is a vulnerability factor for depression via both direct and indirect pathways. Anxiety symptoms should therefore be assessed systematically and treated in order to lessen the likelihood of depression symptoms.

Neuropsychological and Psychiatric Outcomes in Dextro-Transposition of the Great Arteries across the Lifespan: A State-of-the-Art Review

Advances in prenatal diagnosis, perioperative management, and postoperative care have dramatically increased the population of survivors of neonatal and infant heart surgery. The high survival rate of these patients into adulthood has exposed the alarming prevalence of long-term neuropsychological and psychiatric morbidities. Dextro-transposition of the great arteries (d-TGA) is one of the most extensively studied cyanotic congenital heart defect (CHD) with regard to neurodevelopmental outcomes. Landmark studies have described a common neurodevelopmental and behavioral phenotype associated with d-TGA. Children with d-TGA display impairments in key neurocognitive areas, including visual–spatial and fine motor abilities, executive functioning, processing speed, and social cognition. As they grow older, they may face additional challenges with a worsening of deficits in higher order cognitive skills, problems in psychosocial adjustment and a higher-than-expected rate of psychiatric disorders, such as attention-deficit hyperactivity disorder, depression, and anxiety. The aim of this review is to summarize the available recent data on neuropsychological and psychiatric outcomes in individuals with d-TGA after the arterial switch operation. We present findings within a life-span perspective, with a particular emphasis on the emerging literature on adolescent and young adult outcomes. Finally, we propose avenues for future research in the CHD adult neuropsychology field. Among these avenues, we explore the potential mechanisms by which pediatric neurodevelopmental impairments may have lifelong adverse effects as well as alternative interventions that could optimize outcomes.

Rehabilitation following cerebral anoxia: An assessment of 27 patients

Abstract Objectives: (1) To evaluate cognitive and emotional impairments, disability and quality-of-life for adults with cerebral anoxia institutionalized in residential care facilities. (2) To evaluate the efficacy of medication, psychotherapy, support group and therapeutic activities. Methods: Twenty-seven persons with cerebral anoxia were recruited, on average 8 years post-injury. Only 20 went through the whole study. Over three consecutive 2-month periods, they were assessed four times to evaluate: baseline observations (T1–T2), adjustment of their medication (T2–T3); and the effect of psychotherapy, support group and therapeutic activities such as physical and artistic or cultural activities usually proposed in the facilities involved (T3–T4). Examined variables at all time points were cognitive status, anxiety and depression, anosognosia, alexithymia, disability and quality-of-life. Results: All participants exhibited cognitive and emotional impairments comparable to those reported in the literature. Statistical analyses revealed good baseline stability of their condition and no significant effects of changes in medication (between T2 and T3). Conversely, following implementation of psychotherapy, support group and therapeutic activities (between T3 and T4), quality-of-life and social participation were significantly improved. Conclusion: Social participation and quality-of-life for persons instutionalized several years after cerebral anoxia were improved by psychotherapeutic and therapeutic activities.

Anxiety and depression in patients with multiple sclerosis: The mediating effects of perceived social support

BACKGROUND Social support has been identified as a buffering or intervening variable in stressful life events. Research has demonstrated that greater social support is associated with better mental health in multiple sclerosis (MS), but little is known about its links to specific aspects of mental health. We therefore investigated if and how perceived social support modulates depression, anxiety and fatigue in patients with MS. METHODS We recruited 112 patients with MS from three French hospitals and administered a demographic and clinic interview, and self-report measures of perceived social support (Multidimensional Scale of Perceived Social Support), depression and anxiety (Hospital Anxiety and Depression Scale), and fatigue (Fatigue Severity Scale). We then analyzed the relationships between these domains using path analysis. RESULTS The causal path model provided an excellent fit for the data (χ2 = 9.8, p = .778, standardized root mean square residual = 0.043, comparative fit index = 1.00). Results indicated that the level of social support from friends is a predictor of anxiety symptomatology. Thus, anxiety may have both a direct and an indirect impact on fatigue and depression levels. CONCLUSIONS This study highlights the important roles played by perceived social support and anxiety in MS. These should be key pharmacological and non-pharmacological targets for optimizing patient care. (NCT 02-880-553).

Exploratory Study of a Scale of Emotional State for Children with Intellectual and Multiple Disabilities (EREEP)

ABSTRACT We are proposing to build a Scale of Emotional Feeling for Children with Intellectual and Multiple Disabilities (EREEP—French acronym for Echelle de la Representation Emotionnelle de l’Enfant Polyhandicape) in order to assess their subjective emotional feeling, based on video films of their facial expressions. We hypothesize that the “actual” emotional states of such children are not in line with the representations that their entourage have. For that purpose, we conducted a research in a day school for children with Intellectual and Multiple Disabilities with 7 children aged 6 to 13 years old. Our main results are discussed.