Reconsidering frailty from a human and social sciences standpoint: towards an interdisciplinary approach to vulnerability.

Although frailty is an important, well-characterized concept in the provision of medical care to older adults, it has not been linked to the concept of vulnerability developed in the humanities and social sciences. Here, we distinguish between the two main dimensions of vulnerability: a fundamental, anthropological dimension in which people are exposed to a risk of injury, and a relational dimension in which people depend on each other and on their environment. The relational notion of vulnerability might provide healthcare professionals with a better understanding of frailty (and its potential interaction with precarity). Precarity situates people in their relationship with a social environment that might threaten their living conditions. Frailty corresponds to individual-level changes in adaptation to a living environment and the loss of ability to evolve or react in that environment. Therefore, we suggest that by considering the geriatric notion of frailty as a particular form of relational vulnerability, healthcare professionals could better understand the specific needs of frail, older people-and thus provide more appropriate care.

The Clinical Value of the Faux Pas Test for Diagnosing Behavioral-Variant Frontotemporal Dementia.

OBJECTIVE: We studied the clinical value of the faux pas test to diagnose behavioral-variant frontotemporal dementia. METHODS: The faux pas test was administered to patients referred to a memory clinic in a context of behavioral disturbances. The diagnosis of behavioral-variant frontotemporal dementia (n = 14) or not (n = 25) was confirmed after a 3 years follow-up. RESULTS: The faux pas test displayed a high sensitivity for behavioral-variant frontotemporal dementia (.83) however its specificity was only moderate (.64). CONCLUSIONS: Our results confirm that the FPT capture's specific cognitive impairments in patients with behavioral-variant frontotemporal dementia. However, some patients with psychiatric disease or other neurological diseases may also show impaired scores.

Why evaluate one-week-delayed verbal recall in patients with severe traumatic brain injury?

PRIMARY OBJECTIVE: The aim of this study was to propose new measures to evaluate memory processes in patients with severe traumatic brain injury (TBI). In this purpose, we analyzed learning and consolidation processes depending on own patient's performance during a memory test. METHODS: One-week Free and Cued Selective Reminding Test - word version (1W-FCSRT-word), which special feature relies on a 30-min and a 1-week-delayed recall after encoding, was administered to a group of 43 patients with severe TBI (age range from 20 to 54 years) and a group of neurologically healthy volunteers matched for age and gender. RESULTS: Patients performed worse than healthy volunteers for the learning score. Their forgetting percentage was above healthy volunteers' performance and difference between the two groups increased with the delay from the learning phase. CONCLUSION: In patients with severe TBI, our results underlined an altered learning and an impairment of long-term consolidation. It is crucial to detect these deficits in the aim to highlight, with a better accuracy, these patients' memory complaints and to propose a better professional rehabilitation.

A rehabilitation program based on music practice for patients with unilateral spatial neglect: a single-case study.

Two major limitations of unilateral spatial neglect (USN) rehabilitation methods are actually reported: a lack of long-term efficiency and a lack of generalization to daily life. The aim of our case study was to underline how a multisensory method-music practice-could avoid these limitations. Mrs BV suffered from a chronic severe USN. She had rehabilitation sessions of music practice over 8 weeks. An improvement of her USN was found on paper-pencil tests but also in daily activities. Benefits subsisted 4 months after rehabilitation. Music practice seemed to avoid the major limitations of USN rehabilitations and could represent a promising tool.

Exogenous orienting of attention in hearing: a virtual reality paradigm to assess auditory attention in neglect patients.

While mechanisms of orienting attention in unilateral spatial neglect (USN) have frequently been studied in the visual domain, these mechanisms remain relatively unexplored in the auditory domain. Our first goal was to replicate Spence and Driver's (J Exp Psychol Hum 22:1005-1030, 1994) results with a virtual reality paradigm. This paradigm simulated a 3-dimensional auditory space with headphones. Our second aim was to study auditory profiles of orienting attention in USN. In a first experiment, 18 healthy participants performed an auditory cueing spatial paradigm (either a target-detection task or a target-lateralization task). In a second experiment, 14 right-stroke patients (10 with USN and 4 without USN) performed these two same tasks. As in Spence and Driver's (J Exp Psychol Hum 22:1005-1030, 1994), our first experiment showed that spatial representations are not utilized for the detection of auditory stimuli. However, during the lateralization task, participants were quicker to detect targets preceded by a spatially congruent cue, which suggests that our paradigm could be suitable for studying orienting attention in hearing. Our second experiment found that patients with USN also needed an explicit spatial task to be sensitive to auditory spatial cueing. In the target-lateralization task, they showed effects lateralized only to one side of space, whereas patients without USN did not. Although our paradigm needs replications to better understand orienting attention impairments in hearing in USN, this study could have implications for the development of clinical tasks that could assess auditory spatial attention in USN syndrome.

Time reproduction during high and low attentional tasks in Alzheimer's Disease. "A watched kettle never boils".

A wealth of empirical evidence suggests that directing attention to temporal processing increases perceived duration, whereas drawing attention away from it has the opposite effect. Our work investigates this phenomenon by comparing perceived duration during a high attentional and a low attentional task in Alzheimer's Disease (AD) patients since these participants tend to show attentional deficits. In the high attentional task, AD patients and older adults were asked to perform the interference condition of the Stroop test for 15s while in the low attentional task, they had to fixate on a cross for the same length of time. In both conditions, participants were not aware they would be questioned about timing until the end of the task when they had to reproduce the duration of the previously-viewed stimulus. AD patients under-reproduced the duration of previously-exposed stimulus in the high attentional relative to the low attentional task, and the same pattern was observed in older adults. Due to their attentional deficits, AD patients might be overwhelmed by the demand of the high attentional task, leaving very few, if any, attentional resources for temporal processing.

[Home support for vulnerable older people: from shared decision-making to negotiation : A qualitative pilot study]. / L'accompagnement à domicile de personnes âgées vulnérables : de la prise de décision partagée à la négociation : Une étude qualitative pilote.

Shared decision-making allows older people to discuss and change their care with informal caregivers and healthcare professionals. When opinions differ, an older person's decision-making ability can be compromised by many factors. The objective of this qualitative pilot study was to study the dynamics of shared decision-making in home care support for vulnerable older people. Observations were carried out at the older people's homes during appointments with the network's healthcare professionals. Semi structured interviews were then conducted with older people, caregivers and healthcare professionals observed. When opinions differ, negotiation dynamics then develop between older people, caregivers and healthcare professionals. Using a dedicated negotiation framework, we identified four types of negotiation between the stakeholders in home care decision-making, influenced by various articulations of individual, collective and environmental factors.

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 Alzheimer's 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.

Évolution des séquelles cognitivo-comportementales d'un traumatisme cranio-cérébral modéré à sévère plusieurs années après sa survenue. Synthèse et perspectives.

Résumé Chaque année, 150 000 nouveaux cas de traumatismes cranio-cérébraux (TCC) sont recensés en France. Les TCC représentent une cause majeure de handicap chez les sujets jeunes. De nombreuses études se sont intéressées aux conséquences d'un TCC durant les premiers mois, en mettant en évidence des difficultés somatiques et cognitivo-comportementales qui impactent la vie sociale, affective et professionnelle des personnes victimes. Selon la sévérité du TCC, ces difficultés peuvent, totalement ou en partie seulement, régresser durant les premiers mois et jusqu'à deux ans après le TCC. L'évolution puis la consolidation des séquelles cognitivo-comportementales peuvent se poursuivre jusqu'à cinq ans après le TCC. Peu d'études ont porté sur l'évolution des séquelles cognitivo-comportementales avec l'avancée en âge des personnes victimes d'un TCC. Celle-ci semble être influencée par des facteurs spécifiques comme l'âge de survenue du TCC, le sexe, être porteur du gène ApoE4 mais également des facteurs environnementaux comme, la qualité des interactions cognitives et sociales. Abstract Traumatic Brain Injuries (TBI) result in cognitive and behavioral impairment inducing a disability in daily life for the TBI victims, but also for the families in social, professional and emotional domains. Evolution of these consequences has been widely described during the first few months after TBI (up two years after the TBI), but few studies are carried on the becoming of these impairments when TBI subjects are growing old. Evolution seems to be affected by endogenous factors such as gender, age, and ApoE4, and exogenous factors such as social interactions. Some studies suggest that TBI is a risk factor to develop a neurodegenerative disease.

The relationship between cognition and vocational training outcome in patients with acquired brain injury: Contribution of Machine Learning.

The aim of this study was to identify specific cognitive patterns related to long-term vocational training outcome. Records of twenty-eight patients who had benefited from a professional rehabilitation program were retrospectively processed. Screening through machine learning algorithms of patients' neuropsychological scores identified cognitive patterns related to both vocational training outcomes: succeeded or failed. These patterns were based on cognitive performance intervals even if the cognitive ability was not impaired. The cognitive pattern related to a successful vocational training included performance intervals on measures underlying verbal memory consolidation, visual memory incidental recall, problem solving and planning abilities. The cognitive pattern explaining failure of vocational training included performance intervals on tasks involving planning and problem solving abilities. From a comprehensive neuropsychological battery, memory and executive measures appeared to be the best attributes related to the vocational training outcome in patients with brain injury. Even with a cognitive functioning above the pathological cutoff, patients suffering from a brain injury could fail a vocational training. The attributes related to the vocational training outcome would be more a specific level of cognitive functioning rather than an interpretation of neuropsychological scores only based on a normal versus pathological distinction.

Long-term Neurologic Safety in Patients With B-Cell Lymphoma Treated With Anti-CD19 Chimeric Antigen Receptor T-Cell Therapy.

OBJECTIVES: Anti-CD19 chimeric antigen receptor (CAR) T-cell therapy is a promising treatment in relapsing B-cell lymphoma but is frequently associated with acute neurotoxicity. Neurologic long-term safety has not been thoroughly assessed. METHODS: All patients with consecutive refractory lymphoma admitted in our center for CAR T-cell therapy underwent neurologic examination, extensive neuropsychological assessment, and brain MRI (except 1 patient) and completed self-administrated questionnaires at baseline. The patients who remained disease-free at 2 years were re-evaluated similarly. All neurologic assessments were conducted by senior neurologists. RESULTS: None of the 19 disease-free patients developed new neurologic deficits or MRI changes when compared with baseline. There was no difference in cognitive performances before and 2 years after, even for the 11 patients who had developed acute neurotoxicity after CAR T cells. In self-questionnaire assessments, cognitive complaint was stable, reported by 32% of the patients at 2 years. We observed a reduction in HADS anxiety scores 2 years after treatment when compared with baseline (median score: 7/21 vs 4/21, p = 0.01). DISCUSSION: In conclusion, no significant neurocognitive or neurologic disorders were observed in this cohort of patients, 2 years after treatment with anti-CD19 CAR T cells.

Impact of cognitive and behavioural functioning on vocational outcome following traumatic brain injury: a systematic review.

PURPOSE: Individuals with traumatic brain injury (TBI) often present injury-related cognitive and behavioural sequelae hindering a successful professional outcome, even many years after injury. The aim of this study was to investigate cognitive and behavioural factors predicting vocational outcome in the post-acute stages (≥one year) of TBI. METHODS: A systematic review of empirical research about vocational outcome of individuals with TBI was conducted. Studies published in PubMed and PsycINFO from 1 January 1998 to 31 May 2019 were screened. Only studies using the same injury severity criteria (the Glasgow Coma Scale score and/or the duration of post-traumatic amnesia) were selected. RESULTS: We found that (1) self-reported symptoms, (2) Functional Independence Measure and Mayo-Portland Adaptability Inventory Scores, (3) alcohol abuse and mood disorders, and (4) Differentiated Outcome Scale Cognitive Scores in individuals with TBI were highly predictive of the vocational outcome. CONCLUSION: This systematic review emphasized the link between cognitive and behavioural functioning and vocational rehabilitation in individuals with TBI. However, scientific literature lacks cognitive and behavioural models predicting vocational outcome of these individuals, including academic or vocational training. Such models would allow clinicians to improve vocational guidance of these individuals.Implications for rehabilitationCognitive and behavioural assessment is highly important even many years after traumatic brain injury, especially in a social and professional rehabilitation context.Clinicians should integrate objective measures of cognition and behaviour in post-acute phases of traumatic brain injury.Identifying vocational outcome related cognitive and behavioural patterns of functioning would allow clinicians to improve vocational guidance of adults with traumatic brain injury.

Evaluation of mid-term (6-12 months) neurotoxicity in B-cell lymphoma patients treated with CAR T cells: a prospective cohort study.

BACKGROUND: Chimeric antigen receptor-modified T (CAR T) cells are profoundly changing the standard of care in B-cell malignancies. This new therapeutic class induces a significant number of acute neurotoxicity, but data regarding mid- and long-term neurological safety are scarce. We evaluated mid-term neurological safety, with special emphasis on cognitive functions, in a series of adults treated with CAR T cells. METHODS: Patients treated in a single center with CD19-targeted CAR T cells for a relapsing B-cell lymphoma were prospectively followed up by neurologists. Before CAR T-cell infusion, all patients underwent neurological examinations with neuropsychological testing and filled out questionnaires assessing anxiety, depression, and cognitive complaints. Patients surviving without tumor progression were re-evaluated similarly, 6-12 months later. RESULTS: In this prospective cohort of 56 consecutive adult patients treated with CAR T cells, 27 were eligible for mid-term evaluation (median time 7.6 months). Twelve patients developed an acute and reversible neurotoxicity with median duration time of 5.5 days. In all patients, neurological examination on mid-term evaluation was similar to baseline. In self-assessment questionnaires, 63% of patients reported clinically meaningful anxiety, depression, or cognitive difficulties at baseline, a number reduced to 44% at the time of mid-term evaluation. On cognitive assessments, no significant deterioration was found when compared to baseline, in any cognitive functions assessed (verbal and visual memory, executive functions, language, and praxis), even in patients who developed acute neurotoxicity. CONCLUSION: In this cohort of patients treated with CD19-targeted CAR T cells, we found no evidence for neurological or cognitive toxicity, 6-12 months after treatment.

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.

Is Multidimensional Fatigue Inventory (MFI-20) adequate to measure brain injury related fatigue?

BACKGROUND: Fatigue is a common symptom in patients with acquired brain injury (ABI) related disability while its multidimensionality has never been investigated, and specifically its relationship with patients' cognitive functioning. OBJECTIVE: This study aimed to evaluate the validity of the Multidimensional Fatigue Inventory (MFI-20) in patients living with ABI-related disability. METHODS: Four hundred twenty-six participants divided in three different groups (ABI-related disability, physical-related disability without an ABI, and healthy volunteers with no disability) were administered the French version of the Multidimensional Fatigue Inventory. We investigated the link between these fatigue measures and neuropsychological assessment in patients with ABI. Performance on this tool was compared according to the group and we calculated normative data for the Multidimensional Fatigue Inventory based on healthy volunteers' performance. RESULTS: In patients with ABI, fatigue measures significantly correlated with neuropsychological measures of attention, memory and executive functions. We found higher scores on Mental Fatigue and Reduced Activities dimensions in patients with ABI in comparison with the patients with physical disability (p < 0.05) and healthy controls (p < 0.01). CONCLUSIONS: The Multidimensional Fatigue Inventory appeared to be a sensitive tool to detect ABI-related fatigue, fatigue levels being higher than in patients with physical disability and in healthy volunteers. As fatigue appeared to be related to memory, executive and attentional functioning of patients with ABI-related disability who often face unemployment, its impact on vocational outcome following ABI should be further investigated.

[Inhibitory process: what evolution after the age of 50?]. / 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.

[Posterior cortical atrophy]. / L'atrophie corticale postérieure.

Posterior cortical atrophy belongs to the progressive focal atrophy group of neurodegenerative diseases. It is characterized by specific clinical deficits in visual perception, which can affect either visuo-spatial features or identity of objects. The posterior cortical atrophy, initially described by Pick in 1902, is a rare and not well known syndrome. While it is easy to differentiate posterior cortical atrophy from Alzheimer's disease, some cognitive deficits are common with those of Lewy body disease and corticobasal degeneration, which results in diagnostic mistakes. This paper proposes a synthetic review of the posterior cortical atrophy illustrated by a clinical case.

[Cerebral lateralization and hemispheric interaction in aging: what about dichotic listening?]. / Latéralisation cérébrale et interactions hémisphériques chez le sujet âgé : place du test d'écoute dichotique.

Dichotic listening is the most frequent behavioral test used to assess hemispheric lateralization. The subjects simultaneously receive competing information signals in each ear and the attention resources are mobilized. Dichotic listening may be viewed as a dual-task procedure. In fact, executive functions and attention, which are involved, may be modified in elderly. The aim of this paper is to define the role of dichotic listening for the study of hemispheric interactions in the elderly, according to compensation/reorganization processes in normal and pathological aging.

Aging and Orienting of Visual Attention: Emergence of a Rightward Attentional Bias with Aging?

Although some studies described the apparition of a rightward bias of attention with aging, no study has examined if this bias could be explained by modifications based on age in the mechanisms of attention orienting and, specially, in the cueing effects. 48 participants of different ages were tested with a spatial cueing paradigm to assess mechanisms of attention orienting. Our results suggest the appearance of specific difficulties to orient and reorient attention towards the left side of space with aging. These results identified a right attentional anchoring with aging.

How to Assess Executive Functions in a Low-Educated and Multicultural Population Using a Switching Verbal Fluency Test (the TFA-93) in Neurodegenerative Diseases?

Few neuropsychological tests are available to assess executive dysfunction in low-educated and multicultural populations. To address this issue, the TFA-93, a switching verbal fluency test to assess cognitive flexibility, was administered to 70 healthy controls, 57 patients with a clinical diagnosis of Alzheimer's disease, and 21 with a clinical diagnosis of a neurodegenerative disease associated with frontal disorders. Most of the participants were low-educated and nonnative French speakers. The TFA-93 comprises 2 categorical fluency tasks (animals and fruits) and a fluency task in which participants have to switch between animals and fruits. Correct responses and errors were collected, and a flexibility index expressed the switching cost. Results showed that correct responses were lower, and the switching cost was greater in both patient groups. In low-educated and multicultural populations, the TFA-93 seems to be a good alternative to assess flexibility compared to the standard neuropsychological tools based on academic abilities.