[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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Extension to one week of verbal memory consolidation assessment.

OBJECTIVE: Although impairments of long-term recall affect everyday life, they may be missed by standard delayed recall tests, which typically assess the ability to retain new information within a few minutes, without encompassing the consolidation process. We adapted a verbal memory test to evaluate long-term memory consolidation in healthy volunteers. METHOD: A sample of 238 participants (M = 42.23 years old, SD = 16.45) was administered an adapted version of the French RL/RI-16 (Van der Linden & the members of GREMEM, 2004), the One-Week Free and Cued Selective Reminding Test-word version, in which special feature relies on a 30-min and a 1-week-delayed recall after encoding. We proposed normative data on 4 indicators, depending on participants' own performance during the test, to measure their encoding, storage and consolidation abilities, with a method using an ascendant step-by-step linear regression model and a percentile procedure. RESULTS: Results showed a better performance in women than in men for encoding and cueing scores (p < .01 and p < .05, respectively). We also highlighted an increase of the forgetting score according to the recall delay after encoding (30 min vs. 7 days; Z = 12.49, p < .001), the forgetting percentage 7 days after encoding being largely influenced by participants' age and gender (F[2, 236] = 248.1, p < .001; adjusted R2 = 67%). CONCLUSIONS: This study emphasized the role of demographic factors on long-term memory consolidation. The demographically adjusted normative data we provide for the One-Week Free and Cued Selective Reminding Test-word version make it a sensitive tool for long-term memory consolidation assessment in clinical and forensic practice. (PsycINFO Database Record

French Version of the Hayling Sentence Completion Test, Part I: Normative Data and Guidelines for Error Scoring.

OBJECTIVE: The Hayling Sentence Completion Test (HSCT) measures prepotent response inhibition, useful to assess inhibition deficit in a variety of clinical conditions. Despite its extensive use by numerous clinical and research groups in France, normative data for the HSCT are not yet available for French speakers. METHOD: A French version of the HCST was administered to a sample of 426 healthy community-dwelling French speaking adults (20-87 years of age). Normative data were calculated using a regression-based approach. RESULTS: Regression analyses indicated that both age and education were associated with response latency and number of errors in the inhibition condition. Equations to calculate Z scores are provided for clinical use. In addition, we provided a clear guideline for the error scoring of the inhibition condition by establishing a corpus of errors adjusted for the linguistic and cultural realities of the French population. Using this guideline, a good inter-rater reliability was observed. Because of the restricted ranges of response latency and number of errors in the automatic condition, the relationship between these scores and demographic factors was not explored. By consequence, no norms were proposed for this condition. CONCLUSIONS: We provide normative data of a French version of the HSCT for adults and elderly patients. These normative data obtained will be extremely useful for clinical practice and research purposes.

French Version of the Hayling Sentence Completion Test, Part II: Clinical Utility in Schizophrenia and Parkinson's Disease.

OBJECTIVE: We previously developed normative data for a French version of the Hayling Sentence Completion Test (f-HSCT) for adults and elderly people. The present study aimed to evaluate the clinical utility of the f-HSCT norms in two clinical populations in which inhibition dysfunction has been largely documented, i.e., Parkinson's disease (PD) and schizophrenia. METHOD: Eighty-five non-demented patients with idiopathic PD and 64 out-patients with schizophrenia completed the automatic and inhibition conditions of the f-HSCT. Time latencies and errors raw data of each patient were compared to the norms previously developed by the authors. RESULTS: In the automatic condition, errors were rare in both clinical groups and time latencies on this condition felt within the normative data range. Compared with the standardized norms, 46% of patients with PD and 61% of patients with schizophrenia had a deviant performance (i.e., borderline or deficit) for the inhibition error score. The proportion of patients with a deviant performance on the inhibition response time score was similar in both clinical samples (respectively, 25% and 23%). Finally, slightly more than half of patients with PD and more than two-thirds of patients with schizophrenia had a deviant performance on at least one of the f-HSCT inhibition measures. CONCLUSIONS: Our results suggest that the f-HSCT has a strong potential for characterizing inhibition of prepotent responses in PD and schizophrenia. Furthermore, it requires only a short administration time so it may be ideal to detect response inhibition in clinical populations with cognitive fatigue.

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.

The sense of self is supported by several independent cognitive processes in Alzheimer's disease and self-reported age tracks cognitive impairment.

Do patients with Alzheimer's disease loose themselves? The impact of dementia on the sense of self has been extensively studied over the past 15 years. However, most studies investigate only one marker of the self - such as mirror self-recognition or the use of the pronoun "I" - and do not track how this marker evolves in the course of the illness in comparison to other markers. This situation has resulted in fragmented findings rather than converging evidence for a coherent model of the self in dementia. In our two studies, we use a questionnaire to investigate four markers of the self simultaneously (self-knowledge, mirror self-recognition, the bodily distinction between self and other, and self-reported age) in the same 60 patients spread across three stages of Alzheimer's disease. This method allows us to determine whether these markers are impaired independently over the progression of the illness. Our results suggest that the sense of self relies on a complex structure supported by several independent cognitive processes that are impacted differently by the progression of dementia. In particular, despite the early deterioration of self-knowledge, patients at advanced stages of the disease seem to maintain a sense of self, rooted into mirror self-recognition and the bodily self. Furthermore, self-reported age predicts the level of cognitive impairment. We suggest that a better understanding of the stage at which each marker of the self breaks down can help clinicians support their patients better by targeting the preserved dimensions of their identity at any given point in the progression of their condition.

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.

Auditory lateralisation deficits in neglect patients.

Although visual deficits due to unilateral spatial neglect (USN) have been frequently described in the literature, fewer studies have been interested in directional hearing impairment in USN. The aim of this study was to explore sound lateralisation deficits in USN. Using a paradigm inspired by Tanaka et al. (1999), interaural time differences (ITD) were presented over headphones to give the illusion of a leftward or a rightward movement of sound. Participants were asked to respond "right" and "left" as soon as possible to indicate whether they heard the sound moving to the right or to the left side of the auditory space. We additionally adopted a single-case method to analyse the performance of 15 patients with right-hemisphere (RH) stroke and added two additional measures to underline sound lateralisation on the left side and on the right side. We included 15 patients with RH stoke (5 with a severe USN, 5 with a mild USN and 5 without USN) and 11 healthy age-matched participants. We expected to replicate findings of abnormal sound lateralisation in USN. However, although a sound lateralisation deficit was observed in USN, two different deficit profiles were identified. Namely, patients with a severe USN seemed to have left sound lateralisation impairment whereas patients with a mild USN seemed to be more influenced by a systematic bias in auditory representation with respect to body meridian axis (egocentric deviation). This latter profile was unexpected as sounds were manipulated with ITD and, thus, would not be perceived as coming from an external source of the head. Future studies should use this paradigm in order to better understand these two distinct profiles.