Assessment of implicit language and theory of mind in multiple sclerosis.

BACKGROUND: Increasing evidence suggests that social cognition, especially theory of mind (ToM), is impaired in individuals with multiple sclerosis (MS). ToM appears to be a determining factor for social functioning, but research has shown a connection between ToM and pragmatic language disorders among people with neurological or psychiatric disorders. Yet, pragmatic language remains a domain rarely referenced in MS. OBJECTIVE: We investigated the effect of MS in terms of the ability for making inferences via pragmatic understanding and ToM. METHODS: We included 21 individuals with MS and 21 healthy controls matched for age, education and linguistic skills who performed verbal tasks involving pragmatic language (Implicit Information Management Test, Narrative Discourse Task), ToM (Test of Social Faux Pas) and a visual task of making inferences (Visual Inferences Test). RESULTS: Performance was significantly lower for individuals with MS than controls in the Test of Social Faux Pas (total score), but performance in pragmatic tasks did not differ. Performance was significantly lower for MS individuals for logical inference on the Implicit Information Management Test and pragmatic inference on the Visual Inferences Test. Additionally, for the MS group, the total score on the Implicit Information Management Test was correlated with the faux pas test total score and hits. CONCLUSION: Even with lack of marked cognitive decline and disability in individuals with MS and lack of differences between groups in pragmatic tasks, the MS group showed lower performance in making inferences and interpreting implicit and social situations. This study highlights the link between pragmatic language and ToM difficulties in MS.

Initial and long-term evaluation of patients with Alzheimer's after hospitalization in cognitive and behavioural units: the EVITAL study design.

BACKGROUND: Alzheimer's disease and related disorders are characterized by cognitive impairment associated with behavioral and psychological symptoms of dementia. These symptoms have significant consequences for both the patient and his family environment. While risk factors for behavioral disorders have been identified in several studies, few studies have focused on the evolution of these disorders. Moreover, it is important to identify factors linked to the long-term evolution of behavioral disorders, as well as patients' and caregivers' quality of life. Our purpose is to present the methodology of the EVITAL study, which primary objective is to determine the factors associated with the evolution of behavioral disorders among patients with Alzheimer's disease and related disorders during the year following their hospitalization in cognitive and behavioral units. Secondary objectives were 1) to assess the factors related to the evolution of behavioral disorders during hospitalization in cognitive and behavioral units; 2) to identify the factors linked to patients' and caregivers' quality of life, as well as caregivers' burden; 3) to assess the factors associated with rehospitalization of the patients for behavioral disorders in the year following their hospitalization in cognitive and behavioral units. METHOD/DESIGN: A multicenter, prospective cohort of patients with Alzheimer's disease and related disorders as well as behavioral disorders who are hospitalized in cognitive and behavioral units. The patients will be included in the study for a period of 24 months and followed-up for 12 months. Socio-demographic and environmental data, behavioral disorders, medications, patients and caregivers quality of life as well as caregivers burden will be assessed throughout hospitalization in cognitive and behavioral units. Follow-up will be performed at months 3, 6 and 12 after hospitalization. Socio-demographic and environmental data, behavioral disorders, medications, patients and caregivers quality of life, unplanned rehospitalization as well as caregivers burden will also be assessed at each follow-up interview. DISCUSSION: The present study should help better identify the factors associated with reduction or stabilization of the behavioral and psychological symptoms of dementia in patients with Alzheimer's disease. It could therefore help clinicians to better manage these symptoms. TRIAL REGISTRATION: Clinical Trials NCT01901263. Registered July 9, 2013.

The specific disease burden of neuropathic pain: results of a French nationwide survey.

We report the first nationwide survey of the impact of neuropathic pain, as opposed to nonneuropathic pain, on quality of life and health care utilization in the French general population. A postal questionnaire was sent to a representative sample of 4554 respondents from an initial nationwide survey of 30,155 subjects with or without chronic pain. It included pain characteristics (Neuropathic Pain Symptom Inventory, DN4), quality of life (Medical Outcomes Short Form 12, SF-12), sleep, anxiety/depressive symptoms (Hospital Anxiety and Depression Scale) and health care utilization. In total, 3899 (85.6%) questionnaires were returned, 3816 (97.9%) could be assessed and 3165 subjects (82.9%) confirmed their pain status. Subjects reporting pain and neuropathic characteristics based on the DN4 displayed a higher degree of impairment of all dimensions relating to quality of life and sleep and had higher anxiety/depression scores than those reporting pain without neuropathic characteristics and those without pain (P<.01). They also made greater use of health care facilities, particularly as concerned neurological treatments and visits to neurologists (21% vs 9%; P<.01). Multivariate analyses showed that the neuropathic characteristics of pain made an independent contribution to quality-of-life impairment (P<.0001 and P=.0005 for the physical and mental scores of the SF-12 respectively). Our study indicates that the disease burden of chronic pain depends on the nature of the pain, independently of its intensity and duration.

[Assessment of memories for public events in Parkinson's disease]. / Evaluation des souvenirs des événements publics contemporains dans leur composante sémantique et épisodique dans la maladie de Parkinson.

Many patients with Parkinson's disease (PD) have subtle cognitive impairment which often contribute to explain their cognitive complaint. In the literature, neuropsychological studies showed few difficulties for memory and executive functions. We report the performance of 12 PD patients and 12 controls subjects for public events memory. On a 30-item French scale battery (EVE-30), their scores were lower than those of the controls in 4 tasks: evocation, questions, datation and date recognition. They also had difficulties to perform a chronological classification of 8 events. No difference was found between PD patients and control subjects in the events recognition task. Flash bulb memories (FBM) were less frequent in PD patients than in control subjects: 23% versus 34% of cases. A correlation was observed between the scores on the EVE total scale, questions scale, FBM scale and the score on the anterograde recall. Scores on the EVE total scale, questions scale were correlated to the scores on the executive function (initiation) scale. PD patients without dementia seemed to have a low cognitive impairment of retrograde public event memory for episodic and semantic components. Specific difficulties were observed for date evocation and recognition, and chronological classification. These very global deficits to recuperate information can be related to the striatal dopamine depletion which affects the prefrontal functions.

[Assessment of cognitive complaints and depressive symptoms in health check-up centers]. / Exploration de la plainte cognitive dans une population de consultants de Centres d'examens de santé

UNLABELLED: Memory clinics, where cognitive impairment is diagnosed, have to deal with an increasing number of requests. In this context, this study was aimed to evaluate the feasibility of cognitive complaint assessment in a health check-up performed in preventive Health check-up centers. METHODS: The study population included 60-year and over subjects who were proposed a health check-up in the Health check-up centers of five French cities (Amiens, Nîmes, Longwy, Rennes and Sélestat). Cognitive complaint and anxio-depressive symptoms were collected for all participants. Subjects presenting a cognitive complaint fulfilled a neuropsychological screening including MMSE, 5-word test, Clock Drawing test, verbal fluencies and exploration of 4 Instrumental Activities of Daily Living. Subjects suspected to have cognitive impairment were then referred to a memory clinic. RESULTS: One thousand and twenty participants were included in the study; 31.5% had a cognitive complaint, and 12.3% of these subjects were referred to a memory clinic. A dementia was diagnosed in one third of them, corresponding to 1% of the study participants. However, all the patients with dementia were referred by the same check-up centre, which staff was well experienced in cognitive disorders. Moreover, 29.3% of the participants had a depressive symptomatology. CONCLUSION: exploration of cognitive functions in a preventive health check-up center for elderly people can be interesting, but requires a staff's former experience in cognitive disorders, especially for the diagnosis of Mild Cognitive Impairment. Moreover, depressive symptoms, which are frequent and can be cared for, should be explored in a health check-up for senior citizens.

[For a coordination of the supportive care for people affected by severe illnesses: proposition of organization in the public and private health care centres]. / Coordination des soins de support pour les personnes atteintes de maladies graves: proposition d'organisation dans les etablissements de soins publics et privés.

The concept of continuous and global care is acknowledged today by all as inherent to modern medicine. A working group gathered to propose models for the coordination of supportive care for all severe illnesses in the various private and public health care centres. The supportive care are defined as: "all care and supports necessary for ill people, at the same time as specific treatments, along all severe illnesses". This definition is inspired by that of "supportive care" given in 1990 by the MASCC (Multinational Association for Supportive Care in Cancer): "The total medical, nursing and psychosocial help which the patients need besides the specific treatment". It integrates as much the field of cure with possible after-effects as that of palliative care, the definition of which is clarified (initial and terminal palliative phases). Such a coordination is justified by the pluridisciplinarity and hyperspecialisation of the professionals, by a poor communication between the teams, by the administrative difficulties encountered by the teams participating in the supportive care. The working group insists on the fact that the supportive care is not a new speciality. He proposes the creation of units. departments or pole of responsibility of supportive care with a "basic coordination" involving the activities of chronic pain, palliative care, psycho-oncology, and social care. This coordination can be extended, according to the "history" and missions of health care centres. Service done with the implementation of a "unique counter" for the patients and the teams is an important point. The structure has to comply with the terms and conditions of contract (Consultation, Unit or Centre of chronic pain, structures of palliative care, of psycho-oncology, of nutrition, of social care). A common technical organization is one of the interests. The structure has to set up strong links with the private practitioners, the networks, the home medical care (HAD) and the nurses services at home (SSIAD), when they exist, to guarantee the continuity of the supportive care under all its aspects and in order to take into account the preferences of the patients. According to Hospital 2007 propositions, the extended, flexible and general purpose Group of Sanitary Cooperation (GCS) meets the necessities inherent to the structures of supportive care within the territories of health because it can be established between one or several health care centres and the private health professionals, thus favouring the cooperation between public and private health care centres. PSPH and general medicine.