Interest of a Hospital-Based Geriatric Living Lab among Inpatients with Neurocognitive Disorders: The ALLEGRIA Cross-Sectional Study.

INTRODUCTION: The objectives of this study were to determine the participation rates, levels of engagement, and abilities to answer User eXperience (UX) questionnaires according to the presence and severity of major neurocognitive disorders (MNCD) among participants involved in gerontechnological experimentations within a hospital-based geriatric clinical living lab. METHODS: Cross-sectional analysis examining all consecutive geriatric patients involved in the Allegro living lab experimentations, separated according to the presence and severity of MNCD. Participation rates were assessed using the "Task-Based Experiment"-type User eXperience (TBE-UX). Participation was considered successful if patients fully completed the TBE-UX experimental procedure. Engagement level was characterized using a five-point scale: interactive, constructive, active, passive, and disengaged. The abilities to answer UX questionnaires were characterized using a five-point scale from "no completion" to "completion in autonomy." RESULTS: 313 patients were included. All patients without MNCD and with mild MNCD fully completed the TBE-UX procedures. Their engagement behaviors were rather active and constructive. All patients without MNCD and 88% of those with mild MNCD were able to fully complete the UX questionnaires. 96.2% of the patients with moderate MNCD fully followed the TBE-UX procedures. Their engagement behaviors were mainly active or passive. 64.2% were able to fully complete the UX questionnaires. 76.5% of the patients with severe MNCD fully followed the TBE-UX procedures. Their engagement behaviors were mainly passive or disengaged. 35.3% were able to fully complete the UX questionnaires. CONCLUSION: Living lab experimentations appear feasible with older adults, even with those with MNCD. Task support can be offered to those with severe MNCD.

Social cognition in adult survivors of brain tumors: studying the relationship between theory of mind and quality of life.

OBJECTIVE: The present study is the first to examine theory of mind (ToM) sequelae in a sample of adult survivors of primary brain tumors, and to investigate the assumed relationship between ToM and health-related quality of life (HRQoL). METHOD: Participants were 40 long-term adult survivors of primary brain tumors and 40 matched healthy controls. They completed ToM tests (Faux-Pas test and Advanced ToM task) and two questionnaires assessing HRQoL (36-Item Short-Form Health Survey and EORTC QLQ-C30/QLQ-BN20). Their relatives also completed an observer-rated version of the SF-36 questionnaire. RESULTS: Survivors performed worse than controls only on the Advanced ToM task. Overall, patients and caregivers reported more problems than healthy controls and their relatives regarding both global HRQoL and its social/emotional aspects. No relationship was found between ToM and HRQoL scores. CONCLUSION: Adult survivors of primary brain tumors may exhibit ToM deficits several years after treatment and report more problems on social/emotional HRQoL components. Our findings highlight the need to consider these late effects in survivors' long-term follow-up, even if the clinical involvement of ToM deficits still needs to be elucidated. The assessment of ToM deficits and their potential impact on survivors' everyday life is thoroughly discussed.

"Ten euros now" temporal discounting in Huntington disease.

BACKGROUND: When making decisions, one often faces a trade-off between immediate and long-term rewards. In these situations, people may prefer immediate over later rewards, even if immediate rewards are smaller than later ones; a phenomenon known as temporal discounting. In this study, we, for the first time, assessed temporal discounting in three populations: participants with manifest Huntington disease (HD), participants with premanifest HD, and control participants. METHODS: Using the temporal discounting task, we invited participants to choose between small immediate amount of money vs. delayed, but larger amount of money (e.g., "Which do you prefer: you get 10 euros right now or 50 euros in a month?"). We also measured inhibition in order to test if it impacts discounting performance. RESULTS: Analysis demonstrated higher temporal discounting (i.e., a preference for the immediate rewards) in participants with manifest HD compared to those with premanifest HD or control participants, but no significant differences were observed in participants with premanifest HD and control participants. Analysis also demonstrated significant correlations between temporal discounting and scores on an inhibition test in participants with manifest HD, but not in those with premanifest HD or in control participants. DISCUSSION: We suggest that, when making decisions, patients with manifest HD may have difficulties with suppressing the temptation of smaller, but immediate, rewards.

Destination Memory for Self-Related Information: When I Tell Elvis Presley about My Favorite Food.

Destination memory, the ability to remember to whom information was previously delivered, has found to be influenced by social processing and social interactions. This memory has also been shown to be compromised in normal aging. Our paper investigated whether older adults would demonstrate better destination memory for self-related information than for general information. METHODS: We asked younger adults and older adults to tell self-related information (e.g., "I like Chinese food") and semantic information (e.g., "the moon is smaller than the sun") to pictures of celebrities (e.g., Elvis Presley). RESULTS: Analysis showed higher destination memory for self-related information than for semantic information in older adults and younger adults. DISCUSSION: Older adults may draw on self-related information to improve memory and social interactions.

Associations between Adult Primary Brain Tumor Survivors' Behavioral Executive Functions, Health Related Quality of Life and their Caregivers' Health Related Quality : A cross-sectional study.

The present study focused on adult primary brain tumor (PBT) survivors' caregivers. The main objective was to study associations between PBT survivors' health-related quality of life (HRQOL), their behavioral executive functions (EF) and their caregivers' HRQOL. Forty PBT survivors of PBT and 37 caregivers (mostly patient's spouses 81.08%; n = 30) participated in the study. PBT survivors completed a cancer related Quality of Life (QOL) questionnaire. Caregivers completed informant rated HRQOL and behavioral EF reports relating to PBT survivors and a self-rated HRQOL questionnaire relating to themselves. Correlational and multiple regression analyses were conducted. No associations were found between caregivers' physical HRQOL and PBT survivors' HRQOL nor behavioral EF. Analyses yielded several significant correlations between caregivers' mental HRQOL and variables pertaining to PBT survivors' HRQOL and behavioral EF. Multiple regression analyses showed that caregivers' mental HRQOL is predicted by PBT survivors' mental HRQOL, global cancer-related QOL scores and global behavioral EF scores. This study provides evidence suggesting that during the survivorship phase, at an average of 3.67 (SD = 2.31) years following treatment for a PBT, caregivers mental HRQOL is linked to PBT survivors' long-term effects. These findings shed some light regarding post-cancer care for both PBT survivors and their caregivers.

The "Sickness" Memory: Can Patients With Alzheimer Disease Remember the Diagnosis Announcement?

BACKGROUND: Diagnosis of Alzheimer disease (AD) can cause substantial psychological distress in patients. We thus assessed how patients with AD remember the announcement of diagnosis. METHODS: We recruited 47 participants with mild AD (26 women; M age=68.89 y, SD=7.37; M years of formal education=9.74, SD=3.00). We invited the participants to remember the moment when their clinicians announced their diagnosis, within 6 months of the event, as well as a control memory, over the same period. We analyzed memory retrieval regarding specificity, as well as the subjective experience of retrieval (ie, regarding mental time travel, visual imagery, emotion and importance). RESULTS: No significant differences were observed between memory of diagnosis and control memory regarding specificity, mental time travel and visual imagery. However, memory of diagnosis triggered a more intense emotional experience and feeling of importance than control memory. DISCUSSION: Retrieval of the diagnosis announcement can activate a strong emotional and personally important experience in patients with AD. When remembering the diagnosis announcement, patients with AD may re-experience some features of that turning point in which they shift from "person" to "patient."

Apathy and Huntington's Disease: A Literature Review Based on PRISMA.

OBJECTIVE: Although apathy is commonly reported among patients with Huntington's disease (HD), this psychiatric symptom has not yet been clearly defined or extensively studied in HD. Most researchers have adopted descriptive approaches, showing that apathy is a multidimensional entity but leaving the processes underlying its different dimensions relatively unexplored. METHODS: A systematic review of the literature on apathy in HD, focusing on current approaches and measurement tools, was conducted. RESULTS: Searches in PubMed and PubMed Central yielded 368 articles, 25 of which were included in the present review. CONCLUSIONS: This systematic review suggests that more comprehensive research is needed to help shed light on apathy in HD, especially regarding its multidimensional aspect and underlying mechanisms.

Frontal lobe functions in schizophrenia: Interest of the Stuss approach.

OBJECTIVE: The term Executive Functions (EFs) refers to the higher-level skills we use every day to control and coordinate our cognitive abilities and behaviours. EFs are mainly supported by the frontal lobes and its connections. EFs are frequently impaired in schizophrenia, but the profiles of executive deficits accompanying schizophrenia remains unclear. The use of specific EFs models might help to shed new light on this issue. Stuss (Stuss & Alexander, 2007; Stuss, 2008, 2011, 2017) proposed an integrative and operant model of EFs which has never been used to explore and characterize deficits in schizophrenia. The aim of this study is to further examine EFs in schizophrenia in the light of the frontal lobe functional approach developed by Stuss (2008, 2011, 2017) in order to question EFs impairment homogeneity and heterogeneity in schizophrenia. METHODS: Forty-five patients with schizophrenia and fifty-five healthy controls were recruited. They all completed a series of neuropsychological tests selected and adapted to measure the five majors' functions of the frontal lobe described by Stuss (2017). RESULTS: Patients showed deficits in almost all the frontal functions. Inside each frontal lobe function, correlations were observed between all the corresponding measures. The study of profiles highlighted a heterogeneous functioning in schizophrenia. CONCLUSIONS: The model of Stuss (Stuss & Alexander, 2007; Stuss, 2008, 2011, 2017) allows accurate and specific measures of the frontal functions and observation. Beyond "cold" or "hot" EFs division, this integrative approach is helpful to understand links within neurocognition.

"My sympathetic clinician": perception of sympathy by patients with Alzheimer's disease increases when asked to provide autobiographical memories.

BACKGROUND AND AIMS: Autobiographical memory serves to recall past personal experiences and share them with others, promoting social bonding and communication. In this study, we investigated whether encouraging patients with Alzheimer's disease (AD) to share autobiographical memories during formal neuropsychological testing may boost the patient-clinician relationship, and more specifically, the neuropsychologist's level of sympathy as perceived by patients. METHODS: We invited patients with mild AD to perform neuropsychological testing in two conditions. In one condition, we invited patients to retrieve and share two autobiographical memories after testing, while in a control condition, the testing session ended without asking patients to retrieve and share any autobiographical memories. After the two conditions, patients were invited to rate the neuropsychologist's level of sympathy towards them. RESULTS: Analysis demonstrated that patients perceived a higher level of sympathy when their neuropsychologist invited them to retrieve and share past personal experiences. DISCUSSION: By inviting patients with AD to retrieve past personal experiences, clinicians can promote a sense of sharing, create a social bond and, consequently, enhance the therapeutic relationship. In other words, by inviting patients with AD to share autobiographical memories, clinicians can promote a "social glue" with their patients, boosting mutual sympathy and patients' well-being.

"Who will I be?": The future of the self as described by Alzheimer's disease (AD) patients.

We assessed how Alzheimer's disease (AD) patients would imagine their self in the future. AD patients and healthy controls were asked to generate statements beginning with "I-will-be" to describe how they saw themselves or how they wished to be in the future. These statements were analyzed in terms of four self-dimensions, i.e., physical self, social self, psychological self and self-cessation. The latter was investigated to assess how AD patients processed the idea of their own mortality. Findings demonstrated fewer total "I-will-be" statements in AD participants than in controls, suggesting that the construction of future self-concepts becomes weaker in the disease. Our results also demonstrated fewer statements related to the physical-self, the social-self and the psychological-self, and more statements related to self-cessation in AD participants than in controls. These findings suggest that AD patients are highly preoccupied by the idea of death when thinking about the future of their self.

Personality and social memory: High source and destination memory in extroverts.

We evaluated relationship between personality and memory for social interactions. More specifically, we investigated the relationship between extraversion and the ability to remember who told us some information (i.e., source memory) and the ability to remember to whom we told that information (i.e., destination memory). On a source memory task, participants received information from pictures of celebrities; a subsequent recognition test required them to identify the celebrities from whom they had received that information. On a destination memory task, participants were invited to tell information to celebrities; a later recognition task instructed them to identify the celebrity to whom they had previously told that information. Besides the assessment of source and destination memory, participants answered a questionnaire regarding extraversion. Results demonstrated significant positive correlation between extraversion and source memory, as well as significant positive correlation between extraversion and destination memory. In other words, the more participants described themselves as extraverts, the higher their source and destination memory. During social communications (e.g., in a conversation), extraverts may demonstrate high source and destination memory as these individuals typically value social communication, public sharing, and processing of social information.

Influence of emotional complexity on the neural substrates of affective theory of mind.

Affective theory of mind (ToM) depends on both the decoding of emotional expressions and the reasoning on emotional mental states from social situations. While previous studies characterized the neural substrates underlying these processes, it remains unclear whether the nature of the emotional state inferred from others can influence the brain activation associated with affective ToM. In the present study, we focused on two types of emotions: basic emotions (BEs) (e.g., anger and surprise), which are innate and universal and self-conscious emotions (e.g., pride and embarrassment), which correspond to a special class of emotions involving the self and including a representation of one's relative reactions to internal and external standards. Specifically, we used an ecological functional MRI paradigm, on 21 healthy young subjects, to compare brain activations during the decoding of and the reasoning on others' self-conscious, basic and neutral mental states. Our results showed that compared to neutral states, the inference of self-conscious and basic emotional states from others elicited more activation in several core regions of affective ToM. Direct comparisons between emotional conditions revealed more activation for self-conscious than BEs in the right temporoparietal junction during the reasoning process and in left middle occipital regions during the decoding process. Further analyses using a localizer task showed that the extrastriate body area was more recruited for decoding others' self-conscious versus BEs, which emphasize the importance of body clues to properly infer these emotions. Using an original task allowing for an ecological assessment of the affective ToM, these results demonstrate that the complexity of the emotion inferred to others can influence the recruitment of ToM network. This study also validates the use of our task as an ecological tool to assess the affective ToM, constituting an avenue for the characterization of ToM impairments in neurological conditions.

Specific cognitive theory of mind and behavioral dysfunctions in early manifest Huntington disease: a case report.

Huntington's disease (HD) is a devastating illness, associated with progressive motor, behavioral and cognitive dysfunctions. However, some studies emphasized that social cognition impairment could occur prior to the onset of these other symptoms. Here, we report the case of a 47 years old patient with early manifest HD, whose complaint was mainly related to the behavioral sphere. He exhibited a significant impairment of Theory of Mind abilities as well as behavioral, and discrete motor symptoms without noticeable cognitive decline. This case study suggests that social cognition impairments and behavioral changes could be in some cases a feature of the disease and may represent a major disability, in early stages of manifest HD.

The subjective experience of mind wandering in Alzheimer's disease.

Introduction: Little is known about mind wandering in Alzheimer's disease (AD). In this study, we evaluated the subjective experience of mind wandering in AD.Methods: We invited AD patients and control participants to rate the occurrence, intentionality, emotionality, visual imagery, specificity, self-relatedness and temporal orientation of mind wandering.Results: Analysis showed that AD patients rated their mind wandering as more frequent, negative, and more oriented toward the past, but less vivid and specific than that of control participants. No significant differences were observed between AD patients and control participants regarding the intentionality or self-relatedness of mind wandering.Conclusions: These findings demonstrate the negative content in AD. Regarding the reduction of visual imagery and specificity during mind wandering, this reduction may mirror a diminished subjective experience of mind wandering in AD. Regarding temporality, our results may reflect a tendency of AD patients to reminisce over past experiences. Finally, mind wandering in AD seems to trigger significant self-related content.

A Cross-Sectional Study of Treatments for Behavioral Disorders Following Traumatic Brain Injury: Comparison With French Recommendations.

OBJECTIVE: To give a cross-sectional overview of ongoing management of behavioral disorders following traumatic brain injury (TBI) in a region of France, to compare this with recent recommendations from the French Society of Physical Medicine and Rehabilitation (SOFMER), and to evaluate associations between treatments and participant characteristics. SETTING: Outpatients referred to medical or community-based facilities in a region of France. PARTICIPANTS: One hundred twenty-nine adults with moderate to severe TBI, in the postacute period (over 3 months postinjury). DESIGN: Cross-sectional cohort study. MAIN MEASURES: Sociodemographic data, ongoing interventions including psychotherapy and medication, behavioral disorders assessed by the Behavioral Dysexecutive Syndrome Inventory (BDSI). RESULTS: Thirty-three percent of participants received ongoing psychotherapy and 43% were on medication. The most prescribed medications were antidepressants (21%), neuroleptics (18%), anxiolytics (16%), and mood stabilizers (14%). Eighty-five participants (71%) presented a current Behavioral Dysexecutive Syndrome (BDS) according to the BDSI. These participants more frequently received treatment (P = .004), psychotherapy (P = .048), medications (often 2 or more) (P = .007), and particularly antiepileptic mood stabilizers (P = .037) compared with those without BDS. CONCLUSION: Although recommended as first-line treatment, few participants with BDS received psychotherapy. Medications were overused, especially neuroleptics in view of their potential adverse effects. In contrast, recommended medications, such as mood stabilizers and ß-blockers, did not appear to be highly prescribed whatever the evolution. Compliance with recommendations seemed insufficient.

A sociocognitive approach to social problem solving in patients with traumatic brain injury: a pilot study.

PRIMARY OBJECTIVE: Patients with traumatic brain injury (TBI) have difficulty dealing with the social world and may display inappropriate social behavior that negatively affects their social and occupational rehabilitation. This difficulty may be explained by a social problem-solving (SPS) impairment, but little is yet known about the cognitive processes involved in the ability to solve social problems. Several publications have demonstrated that executive functions are related to social problem solving, but the role of social cognition needs to be confirmed. The present pilot study examined the expected relationships between SPS ability and both social cognition and social behavioral skills. RESEARCH DESIGN: We compared the performances of 15 patients with TBI on SPS, theory-of-mind and social behavior tasks with those of 25 matched healthy controls. MAIN OUTCOMES AND RESULTS: Our results showed for the first time that impaired social problem solving is associated with a theory-of-mind deficit, but surprisingly not with executive impairment. There was no evidence that SPS deficits predict social behavioral disorders. CONCLUSIONS: Studying social problem solving in patients with TBI may inform the design of more appropriate methods of social rehabilitation.

Social cognition and traumatic brain injury: current knowledge.

The notion of social cognition is an umbrella term which refers to a set of processes which permit the perception of social cues from the self and others, the interpretation and understanding of own and other's emotions, beliefs and behaviors, and the generation of responses to these inferences to guide social behavior. This paper is an introduction to our special issue of Brain Injury devoted to the study of social cognition after traumatic brain injury.

Frontal Lobe Functions in Normal Aging: Metacognition, Autonomy, and Quality of Life.

BACKGROUND: Starting from the "frontal lobe hypothesis of cognitive aging", we aim to study the metacognitive functions (deception, reciprocity, cognitive and affective theory of mind), autonomy and quality of life in normal aging. METHODS: Eighty healthy subjects (30 young adults [YA] aged 20-40, 30 old adults [OA] aged 65-79 and 20 very old adults [VOA] aged 80 and over) participated in our study. Standard and novel neuropsychological tasks have been used, assessing abilities to understand others' mental and affective states, deceptive and cooperative situations. RESULTS: OA and VOA's performances are significantly poorer than those of YA on first-/second-order false beliefs, deception, reciprocity and emotion recognition tasks. VOA have made more errors than other participants on control false beliefs, general cognition, and memory tasks. Normal aging seems also to be characterized by a reduction in processing speed. The level of instrumental activities of daily living decreases with aging. Theory of mind is associated with individual general cognitive state and executive functions, but not with OA and VOA's levels of autonomy and quality of life. CONCLUSION: In this study, we have shown an age-related deterioration of metacognitive functions, which does not seem to be associated with old adults' autonomy and satisfaction of life. A good level of mental activity could be necessary to maintain satisfactory interpersonal relationships.

Destination memory in social interaction: better memory for older than for younger destinations in normal aging?

Destination memory, a memory component allowing the attribution of information to its appropriate receiver (e.g., to whom did I lend my pen?), is compromised in normal aging. The present paper investigated whether older adults might show better memory for older destinations than for younger destinations. This hypothesis is based on empirical research showing better memory for older faces than for younger faces in older adults. Forty-one older adults and 44 younger adults were asked to tell proverbs to older and younger destinations (i.e., coloured faces). On a later recognition test, participants had to decide whether they had previously told some proverb to an older/younger destination or not. Prior to this task, participants reported their frequency of contact with other-age groups. The results showed lower destination memory in older adults than in younger adults. Interestingly, older adults displayed better memory for older than for younger destinations. The opposite pattern was seen in younger adults. The low memory for younger destinations, as observed in older adults, was significantly correlated with limited exposure to younger individuals. These findings suggest that for older adults, the social experience can play a crucial role in the destination memory, at least as far as exposure to other-age groups is concerned.

Environmental dependency phenomena in schizophrenia: a pilot study.

INTRODUCTION: Environmental dependency phenomena refer to the enslavement of patients' performances under the characteristics of the tasks and were first described in case of prefrontal lobe damage. Two forms of environmental dependency, executive and social, may be dissociated, which involve respectively dorsolateral and orbital prefrontal cortex (PFC) dysfunction. Schizophrenia is widely considered to be caused by PFC dysfunction, but no study to date has addressed environmental dependency in this pathology. METHODS: We compared patients (N = 17) and healthy controls (N = 28) on a task dedicated to the study of environmental dependency. RESULTS: Our results demonstrate the presence of environmental dependency in schizophrenia. Each form of environmental dependency can be highlighted independently, as previously demonstrated by studies with prefrontal patients. CONCLUSIONS: These findings suggest specific prefrontal dysfunction for each subgroup of patients and demonstrate a dissociation between socio-cognitive and neurocognitive performance in schizophrenia. Additionally, we found relationships between symptomatology and environmental dependency. This pilot study supports the relevance of studying environmental dependency to highlight specific patterns of prefrontal disorders in schizophrenia, which may contribute to a better understanding of PFC dysfunction in schizophrenia.