[Gradual approach for the etiological diagnosis of the neurocognitive disorder]. / Approche graduelle pour le diagnostic étiologique des troubles neurocognitifs.

Neurocognitive disorders (TNC) are of a public health concern. An early and accurate diagnosis is important to tailor a personalised care. We illustrate the importance of a graduated etiological diagnostic approach centered on the clinical presentation employing the case of a patient with a progressive neurovisual disorder suggestive of a common form of Alzheimer's disease. The results of the CSF biomarkers analysis argue against this diagnosis and justifies seeking a Lewy body disease as a differential diagnosis even if all the clinical criteria are initially incomplete. In this article, we illustrate the progressive and graduated approach in the use of complementary medical tests available for reliable and early diagnosis in order to optimise the care plan and predict clinical progress and needs.

Les troubles neurocognitifs (TNC) sont un enjeu de santé publique. Un diagnostic précoce et précis est important pour une prise en charge personnalisée. Nous illustrons l'intérêt d'une démarche diagnostique étiologique graduelle centrée sur la clinique à partir du cas d'un patient atteint d'un trouble neurovisuel progressif suggérant une forme commune de maladie d'Alzheimer. L'analyse des biomarqueurs du LCR argumente en défaveur de ce diagnostic et justifie de rechercher comme diagnostic différentiel une maladie à corps de Lewy même si l'ensemble des critères cliniques sont initialement incomplets. Nous discutons dans cet article la démarche progressive et graduelle dans l'emploi des examens complémentaires à disposition pour un diagnostic fiable et précoce afin d'optimiser le plan de soins et de prédire l'évolution clinique et les besoins.

How does attention training work in social phobia: disengagement from threat or re-engagement to non-threat?

Social phobics exhibit an attentional bias for threat in probe detection paradigms. Attention training, whereby probes always replace non-threat in a display presenting both threat and non-threat, reduces attentional bias for threat and social anxiety. However, it remains unclear whether therapeutic benefits result from learning to disengage attention from threat or learning to orient attention towards non-threat. In this experiment, social phobics were randomly assigned to one of four training conditions: (1) disengagement from threat, (2) engagement towards non-threat, (3) disengagement from threat and re-engagement towards non-threat, and (4) a control condition. Effects were examined on subjective and behavioral responses to a subsequent stressor. Data revealed that training to disengage from threat reduces behavioral indices of anxiety. Engagement towards non-threat faces did not have effects in itself. These results support that the difficulty in disengaging attention from threat is a critical process in maintenance of the disorder.