Severe developmental topographical disorientation associated with ADHD and dyscalculia: A case report.

We report the clinical case of AB, a right-handed 19-year-old woman who presents severe developmental topographical disorientation, a relatively rare syndrome, leading to difficulties in navigating in familiar (and novel) environments. This symptomatology appears without acquired cerebral damage (MRI described as normal) nor more global cognitive disability (high degree of education achieved). An extensive assessment of spatial cognition with different aspects of underlying cognitive processes is first presented. Second, the patient's preserved cognitive abilities and her major difficulties in calculation, as well as her attention deficit, as seen in a detailed neuropsychological assessment, are reported. For the first time to our knowledge, we show that developmental topographical disorientation can be associated with other developmental cognitive disorders affecting number processing (dyscalculia) and attention (Attention Deficit-Hyperactivity Disorder (ADHD)). We discuss the links between these different cognitive processes in relation to visuo-spatial working memory and magnitude representation, which could represent common denominators for all these syndromes. This case report highlights the importance of thoroughly assessing potentially associated neurocognitive disorders in developmental topographical disorientation. In addition, it highlights the necessity to keep in mind the prevalence of spatial difficulties in the assessment of children and adolescents with other neurodevelopmental syndromes. Finally, this case study raises a new question about the nosology of developmental disorders affecting the visuo-spatial and spatial domains.

Harmonizing neuropsychological assessment for mild neurocognitive disorders in Europe.

INTRODUCTION: Harmonized neuropsychological assessment for neurocognitive disorders, an international priority for valid and reliable diagnostic procedures, has been achieved only in specific countries or research contexts. METHODS: To harmonize the assessment of mild cognitive impairment in Europe, a workshop (Geneva, May 2018) convened stakeholders, methodologists, academic, and non-academic clinicians and experts from European, US, and Australian harmonization initiatives. RESULTS: With formal presentations and thematic working-groups we defined a standard battery consistent with the U.S. Uniform DataSet, version 3, and homogeneous methodology to obtain consistent normative data across tests and languages. Adaptations consist of including two tests specific to typical Alzheimer's disease and behavioral variant frontotemporal dementia. The methodology for harmonized normative data includes consensus definition of cognitively normal controls, classification of confounding factors (age, sex, and education), and calculation of minimum sample sizes. DISCUSSION: This expert consensus allows harmonizing the diagnosis of neurocognitive disorders across European countries and possibly beyond.

Evolution of Capgras syndrome in neurodegenerative disease: the multiplication phenomenon.

Capgras syndrome (CS) is a delusional misidentification syndrome that is encountered in various pathologies. Here, we report the case of an 83-year-old woman affected by dementia with Lewy bodies who presented a CS during the disease. The neuropsychological assessment showed executive and face processing deficits. In this case, CS was characterized, in the beginning, by the duplication of a relative and then by its multiplication. To our knowledge, the description of the evolution of a CS in the course of a neurodegenerative disease is rare and we discuss this multiplication phenomenon in light of existing models of delusions.

Neuroanatomic Correlates of Distance and Direction Processing During Cognitive Map Retrieval.

Navigating toward a goal and mentally comparing distances and directions to landmarks are processes requiring reading information off the memorized representation of the environment, that is, the cognitive map. Brain structures in the medial temporal lobe, in particular, are known to be involved in the learning, storage, and retrieval of cognitive map information, which is generally assumed to be in allocentric form, whereby pure spatial relations (i.e., distance and direction) connect locations with each other. The authors recorded functional magnetic resonance imaging activity, while participants were submitted to a variant of a neuropsychological test (the Cognitive Map Reading Test; CMRT) originally developed to evaluate the performance of brain-lesioned patients and in which participants have to compare distances and directions in their mental map of their hometown. Our main results indicated posterior parahippocampal, but not hippocampal, activity, consistent with a task involving spatial memory of places learned a long time ago; left parietal and left frontal activity, consistent with the distributed processing of navigational representations; and, unexpectedly, cerebellar activity, possibly related to the role of the cerebellum in the processing of (here, imaginary) self-motion cues. In addition, direction, but not distance, comparisons elicited significant activation in the posterior parahippocampal gyrus.

Perspective taking to assess topographical disorientation: Group study and preliminary normative data.

Difficulty in navigating in a well-known environment (i.e., topographical disorientation) is an incapacitating syndrome. Despite the relatively high frequency after a right cerebral lesion, there is currently a dearth of neuropsychological tests to assess it. We propose a completely new test, the third in a battery of three, which assesses perspective taking, a crucial process in spatial orientation. In this test, inspired from Piaget and Inhelder Three Mountains, the subject must imagine a change in perspective in two conditions: after a rotational or a linear displacement. This task was proposed to 63 patients with a right cerebral lesion and a control group (N = 112). Results show that a right cerebral lesion impairs perspective taking, more specifically when rotation is involved. In addition, the pattern of responses in patients indicates that they have a general deficit in the ability of decentering. Furthermore, we established preliminary normative data taking into account the effect of age and education (there was no effect of gender) on performance. These data indicate that this new test is a good tool in clinical practice for assessing spatial orientation and determining more precisely the symptoms underlying topographical disorientation.

Benton judgment of line orientation test: Examination of four short forms.

Objective: This multicenter retrospective study aimed at examining the clinical accuracy of four 15-item versions (Woodard's O and E; Quall's Q and S) of the original 30-item Benton judgment of line orientation test in a mixed clinical sample of 260 patients. It is a test frequently used as a measure of visuospatial processing. It has the advantage of requiring minimal motor skills, while a major weakness is the lengthy administration time.Method: An archival search was conducted within four in- and out-patient clinics. The frequency and magnitude of score differences were calculated to examine the equivalence of the short forms. We then checked the clinical accuracy of the short forms concerning classification of impaired, borderline, and non-impaired performance, according to NEURONORMA norms. After that, we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa coefficients to assess the classification outcome of the short versions compared to the long version, when using a dichotomous classification (impaired versus intact performance).Results: When applying NEURONORMA norms, specificity (99.1%), PPV (93.1%), and kappa coefficient (0.87) were highest for version E. NPV (99.4%) and sensitivity (95.5%) were highest for version S, but the PPV of this version was relatively low (67.7%).Conclusions: We suggest use of version E when a short test is needed, as specificity, kappa coefficient, and PPV are highest for this version, while maintaining a high NPV (97.8%). However, future research should develop new normative data for these short 15-item versions.

Cognitive map recall test: A new specific test to assess topographical disorientation.

Topographical disorientation, the inability to orient in a well-known environment, is a very incapacitating syndrome. Despite its relatively high frequency after a right cerebral lesion, there is currently no specific neuropsychological test to assess it. We propose a completely new test, with preliminary normative data, assessing the subjects' ability to recall allocentric spatial information from their cognitive map. The subjects are asked to mentally compare distances and directions between landmarks in their familiar environment. This necessitates creating an individual version of the test tailored to every participant's knowledge. This task was proposed to 53 patients with a right lesion and a control group (N = 133). We evaluated performance at comparing distances and directions, and the impact of sociodemographic variables (age, gender, and education). Results show that a right cerebral lesion leads to difficulties in evoking and comparing allocentric spatial information, and more specifically in judging directions. Furthermore, the results show an impact of age, but not gender nor education, on recalling information from a cognitive map. Although there are some intrinsic difficulties (for example in creating patient-specific versions of the test), preliminary normative data indicate that this original test is workable and provides important information in assessing topographical disorientation in clinical practice.

Assessing Mental Imagery to Evaluate Topographical Disorientation: Group Study and Preliminary Normative Data.

There is currently no specific neuropsychological test assessing spatial orientation abilities, despite the fact that navigational deficits are heavily incapacitating in daily life. This lack of a specific test is probably due to theoretical vagueness of concepts in this field and important interindividual differences in spatial cognition. Here we propose a new standardized test assessing a fundamental component of spatial orientation-namely, mental imagery: Adequate mental visualization of the environment is indeed a necessary step in finding one's way. Two conditions of mental imagery were proposed to a group of 58 patients with a right cerebral lesion and to a control group (N = 117). The 1st condition assessed global, categorical imagery; the 2nd evaluated precise, metric imagery. We evaluated performance of the 2 groups in the 2 conditions and the impact of sociodemographic variables (age, gender, education). Results show that the right-lesioned patients presented difficulties in mental imagery, especially in the metric condition. Moreover, the data indicate a global impact of age and a milder effect of education on mental imagery abilities. Although sample sizes are sometimes small, preliminary normative data are given; already in the present form, they are usable and informative in assessing mental imagery, and more generally, spatial orientation, in a clinical practice.

Assessment of Topographical Disorientation: First Application of New Tests and Case Report.

A right posterior cerebral lesion can lead to an inability to orient and can consequently interfere with daily-life autonomy. Despite the wide literature about navigation abilities, it is still difficult to assess topographical disorientation (TD) because of the interindividual specificity of spatial knowledge and the diversity of symptoms. We describe here a set of new tests evaluating spatial cognition in a patient with TD presenting difficulties in navigating inside the hospital and in his hometown more than 3 years after his diffuse ischemic right Sylvian stroke. These tests assess mental imagery (global and specifically spatial imagery), perspective change, and the ability to recall spatial relations in familiar environments. The evaluation revealed difficulties with all the tests (but not in global mental imagery) in this patient when compared with matched controls. Hence, these new tests seem specific and affected by a right hemispheric lesion. The observed deficits can explain, at least partially, the spatial orientation difficulties experienced by this patient in the hospital and familiar environments. In conclusion, these tests could be appropriate tools for the assessment of visuospatial and spatial processes.

Variations in smoking after admission to psychiatric inpatient units and impact of a partial smoking ban on smoking and on smoking-related perceptions.

BACKGROUND: Smoke-related problems are particularly frequent in psychiatry, with additional concerns about iatrogenic effects on smoking in inpatient settings. AIMS: To study the impact of a partial smoking ban on psychiatric patients and staff members. METHODS: Using a pre- and post-intervention design, comparison of smoke-related characteristics and perceptions permitted changes after the introduction of smoking restrictions in 2002 to be studied. Ninety-one inpatients and 110 staff members participated in 2001 before intervention, and 134 inpatients and 85 staff members participated in 2005. RESULTS: After reinforcement of smoking restrictions, no significant changes in smoking prevalence or severity were observed, but there was a change in attitude for patients, more of whom were considering stopping. Daily cigarette consumption after admission changed significantly between 2001 and 2005. A marked decrease after three days in hospital as compared to the week before entry was observed in 2005 (p = 0.005), whereas in 2001 the trend was towards increase (p = 0.06). Furthermore, although the perception of quantity of smoke decreased (p = 0.0005) for both patients and staff, discomfort related to smoke remained unchanged. CONCLUSION: The introduction of a partial smoking ban had favourable effects on patients' cigarette consumption and attitudes, but more efforts need to be pursued.