[Mindful neuropsychology: Mindfulness-based cognitive remediation]. / Mindful neuropsychology : repenser la réhabilitation neuropsychologique à travers la pleine conscience.

OBJECTIVES: Mindfulness based interventions (MBI) have recently gained much interest in western medicine. MBSR paradigm is based on teaching participants to pay complete attention to the present experience and act nonjudgmentally towards stressful events. During this mental practice the meditator focuses his or her attention on the sensations of the body. While the distractions (mental images, thoughts, emotional or somatic states) arise the participant is taught to acknowledge discursive thoughts and cultivate the state of awareness without immediate reaction. The effectiveness of these programs is well documented in the field of emotional response regulation in depression (relapse prevention), anxiety disorders, obsessive-compulsive disorder or eating disorders. Furthermore, converging lines of evidence support the hypothesis that mindfulness practice improves cognition, especially the ability to sustain attention and think in a more flexible manner. Nevertheless, formal rehabilitation programs targeting cognitive disturbances resulting from psychiatric (depression, disorder bipolar, schizophrenia) or neurologic conditions (brain injury, dementia) seldom rely on MBI principles. This review of literature aims at discussing possible links between MBI and clinical neuropsychology. METHODS: We conducted a review of literature using electronic databases up to December 2016, screening studies with variants of the keywords ("Mindfulness", "MBI", "MBSR", "Meditation") OR/AND ("Cognition", "Attention", "Executive function", "Memory", "Learning") RESULTS: In the first part, we describe key concepts of the neuropsychology of attention in the light of Posner's model of attention control. We also underline the potential scope of different therapeutic contexts where disturbances of attention may be clinically relevant. Second, we review the efficacy of MBI in the field of cognition (thinking disturbances, attention biases, memory and executive processes impairment or low metacognitive abilities), mood (emotional dysregulation, anxiety, depression, mood shifts) and somatic preoccupations (stress induced immune dysregulation, chronic pain, body representation, eating disorders, sleep quality, fatigue). In psychiatry, these three components closely coexist and interact which explains the complexity of patient assessment and care. Numerous studies show that meditation inspired interventions offer a promising solution in the prevention and rehabilitation of cognitive impairment. In the last part, we discuss the benefits and risks of integrating meditation practice into broader programs of cognitive remediation and therapeutic education in patients suffering from cognitive disorders. We propose a number of possible guidelines for developing mindfulness inspired cognitive remediation tools. Along with Jon Kabatt Zinn (Kabatt-Zinn & Maskens, 2012), we suggest that the construction of neuropsychological tools relies on seven attitudinal foundations of mindfulness practice. CONCLUSIONS: This paper highlights the importance of referring to holistic approaches such as MBI when dealing with patients with neuropsychological impairment, especially in the field of psychiatry. We advocate introducing mindfulness principles in order to help patients stabilize their attention and improve cognitive flexibility. We believe this transition in neuropsychological care may offer an interesting paradigm shift promoting a more efficient approach towards cognition and its links to emotion, body, and environment.

Does clinical rapid eye movement behavior disorder predict worse outcomes in Parkinson's disease?

Our purpose of this study was to investigate whether clinical rapid eye movement sleep behavior disorder (RBD) is indicative of more widespread degenerative changes in Parkinson's disease (PD), using a longitudinal cohort. In 2005 and 2007, we prospectively collected clinical and treatment characteristics of 61 consecutive patients with PD. The presence of RBD was assessed by spouse interview. Sixty-four percent of patients had clinical RBD in 2005, versus 52% of patients in 2007. The yearly incidence rate of clinical RBD onset was 9%, while clinical RBD disappeared in 14% of patients per year. The motor disability scores (when treated) were worse in patients with than without clinical RBD in 2005, but not in 2007. There was no difference between groups for frequency of freezing, falls, and hallucinations, or for scores on the depression scale, sleepiness scale, mini-mental state examination and frontal assessment battery at the beginning versus the end of the study. Patients with clinical RBD were disabled earlier than patients without RBD, but there was no specific worsening in the RBD group with time, either for motor or non-motor symptoms. The fluctuation and disappearance of clinical RBD in some patients may be due to functional abnormalities rather than lesions.

Nonviolent elaborate behaviors may also occur in REM sleep behavior disorder.

OBJECTIVE: To document unusual, nonviolent behaviors during REM sleep behavior disorder (RBD) and evaluate their frequency in Parkinson disease (PD). BACKGROUND: Most behaviors previously described during RBD mimic attacks, suggesting they proceed from archaic defense generators in the brainstem. Feeding, drinking, sexual behaviors, urination, and defecation have not been documented yet in RBD. METHODS: We collected 24 cases of nonviolent behaviors during idiopathic and symptomatic RBD (narcolepsy, dementia with Lewy bodies, PD), reported or observed in videopolysomnography. The frequency of violent and nonviolent behaviors during RBD was evaluated by face to face interview of patients and their cosleepers in a prospective series of 100 patients with PD. RESULTS: Incidental cases of nonviolent behaviors during RBD included masturbating-like behavior and coitus-like pelvic thrusting, mimicking eating and drinking, urinating and defecating, displaying pleasant behaviors (laughing, singing, dancing, whistling, smoking a fictive cigarette, clapping and gesturing "thumbs up"), greeting, flying, building a stair, dealing textiles, inspecting the army, searching a treasure, and giving lessons. Speeches were mumbled or contained logical sentences with normal prosody. In PD with RBD (n = 60), 18% of patients displayed nonviolent behaviors. In this series (but not in incidental cases), all RBD patients with nonviolent behaviors also showed violent behaviors. CONCLUSIONS: Although they are less frequent than violent behaviors, nonviolent behaviors during REM sleep behavior disorder (RBD) fill a large spectrum including learned speeches and culture-specific behaviors, suggesting they proceed from the cortex activation. Sexual behaviors during RBD may expose patients and cosleepers to forensic consequences.