Non-invasive brain stimulation shows possible cerebellar contribution in transfer of prism adaptation after-effects from pointing to throwing movements.

Whether sensorimotor adaptation can be generalized from one context to others represents a crucial interest in the field of neurological rehabilitation. Nonetheless, the mechanisms underlying transfer to another task remain unclear. Prism Adaptation (PA) is a useful method employed both to study short-term plasticity and for rehabilitation. Neuro-imaging and neuro-stimulation studies show that the cerebellum plays a substantial role in online control, strategic control (rapid error reduction), and realignment (after-effects) in PA. However, the contribution of the cerebellum to transfer is still unknown. The aim of this study was to test whether interfering with the activity of the cerebellum affected transfer of prism after-effects from a pointing to a throwing task. For this purpose, we delivered cathodal cerebellar transcranial Direct Current Stimulation (tDCS) to healthy participants during PA while a control group received cerebellar Sham Stimulation. We assessed longitudinal evolutions of pointing and throwing errors and pointing trajectories orientations during pre-tests, exposure and post-tests. Results revealed that participants who received active cerebellar stimulation showed (1) altered error reduction and pointing trajectories during the first trials of exposure; (2) increased magnitude but reduced robustness of pointing after-effects; and, crucially, (3) slightly altered transfer of after-effects to the throwing task. Therefore, the present study confirmed that cathodal cerebellar tDCS interferes with processes at work during PA and provides evidence for a possible contribution of the cerebellum in after-effects transfer.

Take a Seat and Get Into Its Shoes! When Humans Spontaneously Represent Visual Scenes From the Point of View of Inanimate Objects.

Human description of the surrounding world may spontaneously rely on others' perspective, which is a crucial component of social cognition. In five studies, participants were asked to describe the spatial relations between objects in visual scenes including, or not, other agents. In Experiment 1, a substantial proportion of participants used an other-centered perspective in the presence of another agent, replicating classical findings. To our own surprise, we also observed that an even greater number of participants used an other-centered perspective when the human agent was replaced by an armchair. In order to explore this phenomenon, Experiments 2 to 5 compared the respective strength of chair-centered and agent-centered perspectives and/or set them into conflict. A significant proportion of participants spontaneously took the seat's perspective even when it may not be sat on (Experiments 3 and 4) and even when the seat was not referred to (Experiments 4 and 5). Altogether, these findings suggest that perspective taking may spontaneously apply to inanimate objects. These results question whether such tendencies originate from social cognitive skills-as classically assumed-or reveal a nonsocial phenomenon. Future works should specifically test the widely assumed social nature of spontaneous perspective-taking.

Prisms to Shift Pain Away: Pathophysiological and Therapeutic Exploration of CRPS with Prism Adaptation.

Complex Regional Pain Syndrome (CRPS) is an invalidating chronic condition subsequent to peripheral lesions. There is growing consensus for a central contribution to CRPS. However, the nature of this central body representation disorder is increasingly debated. Although it has been repeatedly argued that CRPS results in motor neglect of the affected side, visual egocentric reference frame was found to be deviated toward the pain, that is, neglect of the healthy side. Accordingly, prism adaptation has been successfully used to normalize this deviation. This study aimed at clarifying whether 7 CRPS patients exhibited neglect as well as exploring the pathophysiological mechanisms of this manifestation and of the therapeutic effects of prism adaptation. Pain and quality of life, egocentric reference frames (visual and proprioceptive straight-ahead), and neglect tests (line bisection, kinematic analyses of motor neglect and motor extinction) were repeatedly assessed prior to, during, and following a one-week intense prism adaptation intervention. First, our results provide no support for visual and motor neglect in CRPS. Second, reference frames for body representations were not systematically deviated. Third, intensive prism adaptation intervention durably ameliorated pain and quality of life. As for spatial neglect, understanding the therapeutic effects of prism adaptation deserves further investigations.

Long-lasting reduction in postural asymmetry by prism adaptation after right brain lesion without neglect.

BACKGROUND: Right brain damage (RBD) involves postural asymmetry and spatial frame disorders. In acute RBD patients, postural asymmetry is immediately reduced after one single session of prism adaptation (PA), without assessment of effects on spatial frames. AIM: To assess long-term effects of PA on posture and spatial frames in chronic RBD patients, without neglect. METHOD: Six chronic RBD patients without neglect (mean delay 45 months) were included. Each patient sustained 10 PA sessions of 20 min during 2 weeks. Outcome measures were: (1) posturographic analysis (mediolateral position of centre of pressure (X cop), (2) subjective straight ahead (SSA) and perception of longitudinal body axis (LBA). Each parameter was assessed by three pretests and three post-tests (+2 h, day + 3 and day + 7). RESULTS: In pretests, patients showed a shift of the X cop and SSA. In post-tests, results displayed (1) a significant reduction in mediolateral postural asymmetry at D + 7; (2) a significant left deviation of SSA at D + 3 and enduring at D + 7; and (3) no significant modification of LBA. The mean curves of X cop and SSA between pre- and post-tests were similar. CONCLUSIONS: PA involves persistent reduction in postural asymmetry in RBD patients without neglect. These findings were obtained at a chronic stage. This new effect cannot be explained by reduction in spatial attentional shift. Improvement may be explained by a better calibration of extra personal space frames used for posture, without effect on personal space frame. Findings argue in favour of a bottom-up effect of PA on mechanisms underlying spatial cognition.

Effector-dependent neglect and splenial disconnection: a spherical deconvolution tractography study.

We present the case of a patient with left homonymous hemianopia and chronic left neglect consequent to a stroke in the occipito-temporal regions of the right hemisphere. When the patient performed cancellation tasks with her right (dominant) hand, she had severe and persistent left neglect at retest 7 and 8 years after onset. However, her performance on line bisection was invariably within normal limits. Strikingly, performance on cancellation tests reverted to normal when the patient used her left hand. White matter tractography using spherical deconvolution demonstrated damage to the splenium of the corpus callosum, as well as a relative preservation of the right fronto-parietal network. Effector-dependent neglect may occur because splenial disconnection deprives the right fronto-parietal network from visual information processed by the left hemisphere. Consequently, spatial exploration reverts to normal when the patient uses her left hand, thus involving more directly the fronto-parietal attentional networks in the right-hemisphere.

Barriers and facilitators for medication adherence in stroke patients: a qualitative study conducted in French neurological rehabilitation units.

OBJECTIVE: To describe the perceptions of French patients, caregivers and healthcare professionals on stroke and secondary preventive medications. METHOD: A qualitative study was conducted, based on four predetermined topics: stroke, secondary prevention medications, patient's experience, relationship between patient/caregiver and healthcare team. RESULTS: Twenty-six interviews were conducted. Difficulties in taking medications, lack of knowledge on stroke and medication benefits, fear of over medication were identified as barriers for adherence in patients. Doubts about generic drugs were expressed by caregivers. Healthcare professionals reported lack of knowledge and absence of clinical symptoms as barriers. On the other hand, support from caregivers and healthcare professional support is essential for compliance in all participants. Patients and caregivers expressed that fear of recurrence was a facilitator for treatment compliance. CONCLUSION: This study highlights the barriers and facilitators for stroke treatment adherence and underlines the similarities and differences between the perceptions of patients, caregivers and healthcare professionals. These results must be integrated into the future French educational programs to improve medication adherence.

Description of an interdisciplinary, holistic cognitive rehabilitation program for adults with mild to moderate cognitive impairment after acquired brain injury.

PURPOSE: Cognitive rehabilitation research has progressed slowly, in part due to incomplete reporting of intervention content and delivery and the difficulties this produces for discerning program effectiveness. This knowledge gap can be reduced by providing detailed intervention descriptions. We document the content/ingredients and therapeutic targets of a cognitive rehabilitation program for adults with mild-to-moderate cognitive impairment. METHODS: The documentation process used a method of participatory/collaborative research. Discussions with the clinical team identified session content/ingredients and therapeutic targets, which were then described using Body Functions, and Activities & Participation domains from the International Classification of Function, Disability and Health (ICF). Domains most frequently targeted by each clinician were identified as Primary Targets. RESULTS: Each clinician produced a detailed description of session content, implementation, and ICF-coded therapeutic targets. This revealed that the whole program targets 29 ICF domains, seven of which were identified as Primary Targets: Higher-level Cognitive; Attention; Memory; Emotional; Global Psychosocial, Temperament and Personality, and Conversation. CONCLUSIONS: Documentation of treatment targets enabled identification of appropriate outcome measures which are now being used to investigate program efficacy. This step-by-step explanation of the documentation process could serve as a guide for other teams wanting to document their rehabilitation interventions and/or establish similar programs.IMPLICATIONS FOR REHABILITATIONIncomplete reporting of intervention content and delivery contributes to difficulties in discerning the effectiveness of complex rehabilitation programs.Current recommendations for rehabilitation intervention reporting suggest that these difficulties can be partially overcome by providing detailed descriptions of intervention content/ingredients and treatment targets.Human and physical resources differ widely from one clinical setting to another and the existence of clear program descriptions can guide clinicians who wish to create similar programs.Detailed descriptions of rehabilitation interventions are necessary to accurately measure patient outcomes and generate testable hypotheses about proposed mechanisms of action.Program descriptions are needed for the development of treatment theories and the advancement of evidence-based practice in rehabilitation.

A systematic review of rehabilitation programs for cognitive impairment related to breast cancer: Different programs at different times?

BACKGROUND: "Cancer Related Cognitive Impairment" (CRCI) defines cognitive disorders related to cancer and its treatments. Many people with breast cancer experience signs of CRCI (incidence between 20 and 30 %) and, although several intervention options exist, there is no established standard of care. Our main objective was to provide a detailed description of the methods and results of randomized controlled trials of interventions for CRCI in breast cancer survivors, paying particular attention to the timing of the interventions within the care pathway. METHODS: We conducted a systematic literature review following the PRISMA guidelines from 01 to 01-2019 to 16-07-2023 and included randomized controlled trials of interventions for CRCI after breast cancer with at least one objective cognitive assessment as a primary or secondary outcome. RESULTS: Among 228 identified studies, 35 (including 2821 participants) were retained for inclusion. The interventions were classified into 4 categories: cognitive rehabilitation, physical activity, complementary therapy and pharmacological treatment. Our analysis revealed that pharmacological interventions have no effect, whereas physical activity interventions proposed in the months following the initial cancer treatment improve Quality of Life and Speed of Information Processing while interventions proposed later improve Memory and Attention (Cognitive Rehabilitation) and Perceived Cognitive Function and Depression/Anxiety/Mood (Complementary Therapies). CONCLUSION: CRCI is multifactorial and affected individuals frequently experience high levels of fatigue, pain, anxiety and depression and are most likely to benefit from holistic approaches that include cognition, physical activity, relaxation, psychoeducation, group support and/or psychological counselling. Thus, rehabilitation programs should be designed on multi-modal approaches, using innovative, cost-effective delivery methods that increase access to treatment, and intervention outcomes should be evaluated using measures of participation. DATABASE REGISTRATION: The review was recorded on Prospero (01-03-2020), with the registration number 135,627.

No inherent left and right side in human 'mental number line': evidence from right brain damage.

Spatial reasoning has a relevant role in mathematics and helps daily computational activities. It is widely assumed that in cultures with left-to-right reading, numbers are organized along the mental equivalent of a ruler, the mental number line, with small magnitudes located to the left of larger ones. Patients with right brain damage can disregard smaller numbers while mentally setting the midpoint of number intervals. This has been interpreted as a sign of spatial neglect for numbers on the left side of the mental number line and taken as a strong argument for the intrinsic left-to-right organization of the mental number line. Here, we put forward the understanding of this cognitive disability by discovering that patients with right brain damage disregard smaller numbers both when these are mapped on the left side of the mental number line and on the right side of an imagined clock face. This shows that the right hemisphere supports the representation of small numerical magnitudes independently from their mapping on the left or the right side of a spatial-mental layout. In addition, the study of the anatomical correlates through voxel-based lesion-symptom mapping and the mapping of lesion peaks on the diffusion tensor imaging-based reconstruction of white matter pathways showed that the rightward bias in the imagined clock-face was correlated with lesions of high-level middle temporal visual areas that code stimuli in object-centred spatial coordinates, i.e. stimuli that, like a clock face, have an inherent left and right side. In contrast, bias towards higher numbers on the mental number line was linked to white matter damage in the frontal component of the parietal-frontal number network. These anatomical findings show that the human brain does not represent the mental number line as an object with an inherent left and right side. We conclude that the bias towards higher numbers in the mental bisection of number intervals does not depend on left side spatial, imagery or object-centred neglect and that it rather depends on disruption of an abstract non-spatial representation of small numerical magnitudes.

Left-deviating prism adaptation in left neglect patient: reflexions on a negative result.

Adaptation to right-deviating prisms is a promising intervention for the rehabilitation of patients with left spatial neglect. In order to test the lateral specificity of prism adaptation on left neglect, the present study evaluated the effect of left-deviating prism on straight-ahead pointing movements and on several classical neuropsychological tests in a group of five right brain-damaged patients with left spatial neglect. A group of healthy subjects was also included for comparison purposes. After a single session of exposing simple manual pointing to left-deviating prisms, contrary to healthy controls, none of the patients showed a reliable change of the straight-ahead pointing movement in the dark. No significant modification of attentional paper-and-pencil tasks was either observed immediately or 2 hours after prism adaptation. These results suggest that the therapeutic effect of prism adaptation on left spatial neglect relies on a specific lateralized mechanism. Evidence for a directional effect for prism adaptation both in terms of the side of the visuomanual adaptation and therefore possibly in terms of the side of brain affected by the stimulation is discussed.

Does anodal cerebellar tDCS boost transfer of after-effects from throwing to pointing during prism adaptation?

Prism Adaptation (PA) is a useful method to study the mechanisms of sensorimotor adaptation. After-effects following adaptation to the prismatic deviation constitute the probe that adaptive mechanisms occurred, and current evidence suggests an involvement of the cerebellum at this level. Whether after-effects are transferable to another task is of great interest both for understanding the nature of sensorimotor transformations and for clinical purposes. However, the processes of transfer and their underlying neural substrates remain poorly understood. Transfer from throwing to pointing is known to occur only in individuals who had previously reached a good level of expertise in throwing (e.g., dart players), not in novices. The aim of this study was to ascertain whether anodal stimulation of the cerebellum could boost after-effects transfer from throwing to pointing in novice participants. Healthy participants received anodal or sham transcranial direction current stimulation (tDCS) of the right cerebellum during a PA procedure involving a throwing task and were tested for transfer on a pointing task. Terminal errors and kinematic parameters were in the dependent variables for statistical analyses. Results showed that active stimulation had no significant beneficial effects on error reduction or throwing after-effects. Moreover, the overall magnitude of transfer to pointing did not change. Interestingly, we found a significant effect of the stimulation on the longitudinal evolution of pointing errors and on pointing kinematic parameters during transfer assessment. These results provide new insights on the implication of the cerebellum in transfer and on the possibility to use anodal tDCS to enhance cerebellar contribution during PA in further investigations. From a network approach, we suggest that cerebellum is part of a more complex circuitry responsible for the development of transfer which is likely embracing the primary motor cortex due to its role in motor memories consolidation. This paves the way for further work entailing multiple-sites stimulation to explore the role of M1-cerebellum dynamic interplay in transfer.

Multiprofessional intervention to improve adherence to medication in stroke patients: a study protocol for a randomised controlled trial (ADMED AVC study).

INTRODUCTION: Adherence to secondary preventive medications is often suboptimal in patients with stroke, exposing them to an increased risk of recurrent cerebral and/or cardiovascular events. Effective actions in the long term to improve adherence to medication are needed. The study will evaluate the efficacy of a collaborative multiprofessional patient-centred intervention conducted by a pharmacist on adherence to secondary preventive medication in stroke survivors. METHODS AND ANALYSIS: This is a multicentre cluster-randomised controlled trial. Two groups of 91 patients (intervention vs standard care) will be recruited. The clinical pharmacist intervention targeting secondary preventive medication will consist of three parts over 1 year: (1) an individual semi-structured interview at hospital discharge; (2) follow-up telephone interviews at 3, 6 and 9 months after discharge; and (3) a final individual semi-structured interview 1 year after discharge. Information on patient follow-up will be shared with the general practitioner and the community pharmacist by sending a report of each interview. The primary outcome is adherence to medication during the 12 months after hospital discharge, assessed using a composite endpoint: the medication possession ratio associated with a self-administered questionnaire. ETHICS AND DISSEMINATION: The local ethics committee, the national committee for use of personal data in medical research and the national data protection agency approved the study. The sponsor has no role in study design; collection, analysis and interpretation of data; or report writing. DISCUSSION: This pharmacist-led educational programme has the potential to significantly improve adherence to medication in stroke survivors which could lead to a decrease in recurrent cerebral and/or cardiovascular events. TRIAL REGISTRATION NUMBER: NCT02611440.

Stroke patients' support: evaluation of knowledge, practices and training needs of French community pharmacists.

Background Stroke represents a major Public Health issue in industrialized countries because of its frequency and severity. In secondary stroke prevention, treatment efficacy is correlated to medication adherence. However, it remains suboptimal in stroke patients. Community pharmacists, in light of their positioning in the care pathway and proximity to patients, can play an essential role in patient support and improving treatment adherence. However, it is currently unknown whether pharmacists are ready to perform this task. Objective Evaluate knowledge, practices and training needs for community pharmacists in therapeutic stroke management to improve long term care for stroke patients. Setting Community pharmacies in the Rhone Alpes region (France). Method We conducted a cross sectional study via a standardized self-assessment questionnaire consisting of 40 questions divided into three parts. The latter was designed by a multidisciplinary team and distributed electronically to community pharmacists of the Rhône-Alpes region (France). Main outcome measure (a) global knowledge score on the pathology, risk factors and clinical care management, (b) description of the support practices for stroke patients, (c) training needs for pharmacists. Results The 104 participants presented a moderate level of knowledge (global score: 12/20 ± 3). Topics best mastered were: pathophysiology, target blood pressure and place of antiplatelets in the therapeutic strategy. Knowledge items that needed improvement were: warning signs correctly identified by 44% of participants, time delay for thrombolysis for which 14% answered correctly, target glycated hemoglobin levels were correct for 41%, and the 3 recommended antihypertensive drug classes were only identified by 5% of participants. Patient education received from pharmacists concerned dosage (89%), treatment adherence (88%), benefits (66%) and administration modalities of medicines (64%), management of risk factors (75% for diet, 73% for physical activity, 70% for smoking and 53% for alcohol). All pharmacists wanted additional training on risk factors and clinical management guidelines. Conclusion Based on this small study, the fragmented knowledge and varied practices promote the need for further training for pharmacists to optimize support of stroke patients. This study promotes the elaboration of training systems adapted to pharmacists' needs. This will help support the development of a targeted pharmaceutical care approach for stroke patients.

Effects of prismatic adaptation on balance and postural disorders in patients with chronic right stroke: protocol for a multicentre double-blind randomised sham-controlled trial.

INTRODUCTION: Patients with right stroke lesion have postural and balance disorders, including weight-bearing asymmetry, more pronounced than patients with left stroke lesion. Spatial cognition disorders post-stroke, such as misperceptions of subjective straight-ahead and subjective longitudinal body axis, are suspected to be involved in these postural and balance disorders. Prismatic adaptation has showed beneficial effects to reduce visuomotor disorders but also an expansion of effects on cognitive functions, including spatial cognition. Preliminary studies with a low level of evidence have suggested positive effects of prismatic adaptation on weight-bearing asymmetry and balance after stroke. The objective is to investigate the effects of this intervention on balance but also on postural disorders, subjective straight-ahead, longitudinal body axis and autonomy in patients with chronic right stroke lesion. METHODS AND ANALYSIS: In this multicentre randomised double-blind sham-controlled trial, we will include 28 patients aged from 18 to 80 years, with a first right supratentorial stroke lesion at chronic stage (≥12 months) and having a bearing ≥60% of body weight on the right lower limb. Participants will be randomly assigned to the experimental group (performing pointing tasks while wearing glasses shifting optical axis of 10 degrees towards the right side) or to the control group (performing the same procedure while wearing neutral glasses without optical deviation). All participants will receive a 20 min daily session for 2 weeks in addition to conventional rehabilitation. The primary outcome will be the balance measured using the Berg Balance Scale. Secondary outcomes will include weight-bearing asymmetry and parameters of body sway during static posturographic assessments, as well as lateropulsion (measured using the Scale for Contraversive Pushing), subjective straight-ahead, longitudinal body axis and autonomy (measured using the Barthel Index). ETHICS AND DISSEMINATION: The study has been approved by the ethical review board in France. Findings will be submitted to peer-reviewed journals relative to rehabilitation or stroke. TRIAL REGISTRATION NUMBER: NCT03154138.

Constraint therapy versus intensive training: implications for motor control and brain plasticity after stroke.

Many studies have demonstrated that constraint induced movement therapy (CIMT) improves upper limb motor impairment following stroke. This rehabilitation method combines constraint of the less-affected upperlimb with intensive training of the paretic limb. The aim of the present study was to evaluate, in a single case study, the respective effects of each of these two therapeutic interventions. The patient selected was a 32-year-old right-handed woman. Three and a half years prior to inclusion, she suffered a left capsular infarct responsible for a right hemiparesis. Several assessments were carried out before and after constraint therapy and then after intensive training. Each assessment included measures of hand function as well as a three-dimensional (3D) analysis of prehension. Results showed a significant improvement of motor performance after the constraint period and an additional amelioration after the intensive training period. Kinematic analysis showed that the transport phase of movement (movement time and velocity peaks) was improved after the constraint period, whereas the grasping phase (maximum grip aperture) was modified after intensive training. These data could reflect a specific effect of treatment on each phase of the prehension task, or a more general proximal-to-distal gradient of recovery. Although firm conclusions are not warranted on the basis of this single case study, we confirm the utility of 3D motion analysis to evaluate objectively the effectiveness of a therapeutic intervention. We also discuss the implications of our findings for understanding processes of motor control reorganisation.

Prisms adaptation improves haptic object discrimination in hemispatial neglect.

Neglect manifestations are typically explored in the visual modality. Although they are less commonly investigated tactile deficits also exist, and the aim of this study was to explore neglect in this modality. A haptic object discrimination task was designed to assess whether or not shape perception is impaired in seven right brain damaged patients with or without neglect. Each patient's performance on the object discrimination task was assessed before and after a brief period of prism adaptation, a bottom-up rehabilitation technique known to improve neglect symptoms. The results suggest that a haptic deficit - in the form of substantially more left errors - is present only in patients with neglect. Following prism adaptation, the left bias error rates in neglect patients were substantially reduced, and were similar to those observed in patients without neglect. Moreover, the haptic processing of the right side of objects also improved slightly. This finding suggests an expansion of the effects of prism adaptation to the unexposed, tactile modality supporting the cross-modal central effect hypothesis.

Association between prism adaptation and auditory cues on spatial navigation in individuals with unilateral neglect.

BACKGROUND: Unilateral neglect is common among right-hemispheric stroke individuals and also concerns the auditory modality. Prism adaptation can improve auditory extinction during a dichotic listening task, but its effect during an ecological task has not been studied. OBJECTIVE: The main objective was to evaluate whether lateralized cueing before and after prism adaptation improved virtual spatial navigation of stroke individuals with visual and auditory unilateral neglect. Secondary objectives were to assess spatial memory and obtain a better understanding of the mechanism of the cueing treatment by using an eye-tracker. METHODS: We included 22 stroke individuals with left visual and auditory neglect, 14 individuals without neglect, and 12 healthy controls. After a familiarization task, participants underwent 3 evaluation sessions. Participants were first passively shown a path that they had then to actively reproduce by using a joystick. A path with lateralized beeping sounds indicating direction and a path without any sounds were followed in a randomized order. After prism adaptation, the participants followed a third path with lateralized beeping sounds. The time of navigation and number of trajectory mistakes were recorded. After navigation, spatial memory was assessed. Additionally, an eye-tracker was used during the navigation period. RESULTS: The navigational performance of participants with neglect was significantly better with than without auditory cues, especially after prism adaptation. With auditory cues, participants without neglect reached the navigational performance of healthy controls. The spatial memory of individuals with neglect was significantly lower with auditory cues. Eye-tracking analyses showed that participants with neglect made more saccades and looked longer at the right-square angles in the absence of auditory cues. CONCLUSIONS: This study demonstrates the positive effect of auditory cues in virtual spatial navigation of individuals with visual and auditory neglect and the potentiation of the help of cues after prism adaptation.

A clinical screening tool for objective and subjective cognitive disorders in multiple sclerosis.

BACKGROUND: Cognitive dysfunction is common in multiple sclerosis (MS). Deficits can affect attention, concentration, planning, and memory. They can have severe functional consequences in many domains. Cognitive complaints are frequently associated with other confounding factors (fatigue, anxiety, depression, or treatment side effects). In most cases, cognitive assessment is proposed after a spontaneous complaint, but determining the extent of discomfort perceived by the patient, the influence of coexisting factors, or the optimal timing for a more complete neuropsychological assessment is difficult. OBJECTIVE: The objective of this work was to evaluate the feasibility and relevance of a fast global assessment of both objective and subjective cognitive dysfunction in MS. METHODS: MS patients underwent a brief cognitive assessment including 7 visual analogue scales (VASs) asking about the patient's subjective level of discomfort in various domains, a memory test (Barbizet's lion story), a commonly used test of information processing speed (Symbol Digit Modalities Test [SDMT]) and self-reporting questionnaires for fatigue and mood (Fatigue Severity Scale [FSS] and Hospital Anxiety and Depression Scale [HADS]). Spearman correlation coefficients among scores were estimated. RESULTS: The mean age of the 73 patients included was 48.3 (SD 11.1) years; 78% were females and 52.8% had the remittent-recurrent MS form, 8.3% the primary progressive form, and 38.9% the secondary progressive form. In less than 20min, this brief cognitive assessment was able to identify symptoms and quantify discomfort level. Symptoms of fatigue and anxiety frequently coexisted with cognitive complaints. We found modest correlations between scores on the VAS fatigue and the FSS and between scores on the VAS mood and the HADS. Analytical evaluation revealed that most patients had similar SDMT and recall profiles; however, a small proportion showed a dissociation between these 2 tests, which validated the inclusion of both tests in the assessment. Accounting for coexisting factors (e.g., anxiety and fatigue) and their functional repercussions is essential for prioritizing these problems within the context of multidisciplinary patient treatment. CONCLUSION: Considering the possible multifactorial character of cognitive dysfunction in MS, it is essential to ask patients about their experiences and to take into account cognitive complaints in the follow-up of patients. The assessment tool we propose is simple and easy to use in a clinical setting and provides the information necessary for requesting (or not) a more complete neuropsychological assessment.

Numerical cognition: A meta-analysis of neuroimaging, transcranial magnetic stimulation and brain-damaged patients studies.

This article offers the first comprehensive review examining the neurocognitive bases of numerical cognition from neuroimaging, Transcranial Magnetic Stimulation (TMS) and brain-damaged patients studies. We focused on the predictions derived from the Triple Code Model (TCM), particularly the assumption that the representation of numerical quantities rests on a single format-independent representation (i.e., the analogical code) involving both intraparietal sulci (IPS). To do so, we conducted a meta-analysis based on 28 neuroimaging, 12 TMS and 12 brain-damaged patients studies, including arithmetic and magnitude tasks in symbolic and non-symbolic formats. Our findings generally agree with the TCM predictions indicating that both IPS are engaged in all tasks. Nonetheless, the results of brain-damaged patients studies conflicted with neuroimaging and TMS studies, suggesting a right hemisphere lateralization for non-symbolic formats. Our findings also led us to discuss the involvement of brain regions other than IPS in the processing of the analogical code as well as the neural substrate of other codes underlying numerical cognition (i.e., the auditory-verbal code).

Regression of left hyperschematia after prism adaptation: A single case study.

Prism adaptation (PA) is a promising treatment in the rehabilitation of post-stroke cognitive disorders such as unilateral spatial neglect or constructional deficits. Right brain damage can bring about another representational spatial disorder, termed «hyperschematia¼, and defined by a left-sided disproportionate expansion of drawings by copy and from memory, and by an overestimation of left lateral extent when a leftward movement is required. This case study aimed at evaluating the effect of PA induced by prismatic lenses creating a shift to the left on hyperschematia signs. A 63-year-old woman with left hyperschematia, consecutive to a right fronto-temporo-parietal hematoma, was exposed to a leftward optical deviation produced by prismatic lenses. An anatomical MRI studied topography of the brain lesion; the patient's lesion was then mapped onto tractography reconstructions of white matter pathways. Results showed that PA significantly reduced the left-sided expansion of drawing by copy and from memory, and the overestimation of left lateral extent, immediately after prism removal and 4 days later, indicating a persistent long lasting cognitive effect. MRI showed a right hemisphere disconnection of the posterior and long segments of the arcuate fasciculus, and of the inferior longitudinal and fronto-occipital fasciculi. Overall, these findings suggest that: i) PA is effective also in hyperschematia by re-orientating spatial attention towards the right side of space, with a relative rightward PA-induced unbalance, and re-setting the spatial representation to the left side of space, contralateral to the side of the lesion; ii) the left misrepresentation of lateral extent may be related to a disconnection between visual coordinates and attentional networks to the frontal lobe.