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INTRODUCTION A significant proportion of prematurely born children encounter behavioral difficulties such as attention deficit or hyperactivity which could be due to executive function disorders. AIMS To examine whether the standard neurodevelopmental assessment offered to premature children in Switzerland recognizes executive function disorders. METHODS The study population consisted of 49 children born before 29 weeks of gestation who were examined between 5 and 6 years of age with a standard assessment with additional items to assess executive functioning. Children with severe neurodevelopmental impairment were excluded (mental retardation cerebral palsy autism). Standard assessment consisted in the Kaufman Assessment Battery for Children (K ABC) which comprises three subscales: sequential processes (analysis of sequential information) simultaneous processes (global analysis of visual information) and composite mental processes (CMP) (result of the other two scales) as well as a behavioral evaluation using the standardized Strengths and Difficulties Questionnaire (SDQ). Executive functioning was assessed with tasks evaluating visual attention divided attention and digit memory as well as with a specialized questionnaire the Behavior Rating Index of Executive Functions (BRIEF) which evaluates several aspects of executive function (regulation attention flexibility working memory etc). RESULTS Children were divided according to their results on the three K ABC scales (85) and the different neuropsychological tasks assessing executive function were compared between the groups. The CMP did not differentiate children with executive difficulties whereas a score < 85 on the sequential processes was significantly associated with worse visual and divided attention. There was a strong correlation between the SDQ and the BRIEF questionnaires. For both questionnaires children receiving psychotherapy had significantly higher results. Children who presented behavioral problems assessed with the SDQ presented significantly higher scores on the BRIEF. CONCLUSION A detailed analysis of the standard neurodevelopmental assessment allows the identification of executive function disorders in premature children. Children who performed below 85 on the sequential processes of the K ABC had significantly more attentional difficulties on the neuropsychological tasks and therefore have to be recognized and carefully followed. Emotional regulation had a strong correlation with behavioral difficulties which were suitably assessed with the SDQ recognized by the families and treated.

Background Few studies looked at the association between gait variability and executive subdomains (ESD). The aim of this study was to examine the association between ESD (i.e., information updating and monitoring) and stride time variability among healthy older adults. Methods Seventy-eight healthy older adults (mean age 69.9 ± 0.9 years, 59% women) were divided into 3 groups according to stride time variability (STV) tertiles while steady state walking. Coefficient of variation of stride time was used as a marker of STV. Scores on cognitive tests evaluating information updating and monitoring (Digit Span test), mental shifting (Trail Making Test part A and part B) and cognitive inhibition (Stroop Color Word test) were used as measures of ESD. Results The full adjusted and the stepwise backward logistic regression models showed that the highest tertile (i.e., the worst performance) of STV was only associated with lower Digit Span performance (Odds ratio = 0.78 with P = 0.020 and Odds ratio = 0.81 with P = 0.019). Conclusions Information updating and monitoring are associated with STV in the sample of studied participants, suggesting that walking may be a complex motor task depending specifically of this subdomain of executive functions.

The results from several studies assessing the executive function in depressed patients compared to control subjects varied from significant impairment to normal performance. To assess the executive impairment in elderly patients with major unipolar depression and to evaluate the influence of psychomotor retardation and severity of depression in the executive deficits, the performance of 15 elderly patients with unipolar depression was compared to that of 15 elderly control subjects on executive tasks. The severity of depression was evaluated by the Montgomery and Asberg depressive scale and that of psychomotor retardation by the Widlöcher's scale. In depressed patients, deficits were found on tasks assessing cognitive flexibility (Modified card sorting test (MCST) and Trail making test B), planification and elaboration of strategies (cognitive estimates), motor initiation (graphic sequences), categorisation and hypothesis making (MCST) and interference resistance (Stroop test). However, depressed patients performed normally on the Hayling test assessing the inhibition processes. Intensity of psychomotor retardation was not correlated to the performance of executive tasks. Conversely, severity of depression was related to the scores of MCST (number of errors and perseverations), Stroop and Hayling tests (time taken to complete the end of the sentence). Unipolar depressed patients showed deficits in most tasks assessing executive function. However, inhibition processes appeared to be intact in depressed patients although their implementation was difficult. The severity of depression but not that of psychomotor retardation was associated with executive deficits.

Following post-traumatic impairment in executive function, failure to adjust to communication situations often creates major obstacles to social and professional reintegration. The analysis of pathological verbal communication has been based on clinical scales since the 1980s, but that of nonverbal elements has been neglected, although their importance should be acknowledged.The aim of this research was to study non-verbal aspects of communication in a case of executive-function impairment after traumatic brain injury.During the patient's conversation with an interlocutor, all nonverbal parameters - coverbal gestures, gaze, posture, proxemics and facial expressions - were studied in as much an ecological way as possible, to closely approximate natural conversation conditions. Such an approach highlights the difficulties such patients experience in communicating, difficulties of a pragmatic kind, that have so far been overlooked by traditional investigations, which mainly take into account the formal linguistic aspects of language.The analysis of the patient's conversation revealed non-verbal dysfunctions, not only on a pragmatic and interactional level but also in terms of enunciation. Moreover, interactional adjustment phenomena were noted in the interlocutor's behaviour.The two inseparable aspects of communication - verbal and nonverbal - should be equally assessed in patients with communication difficulties; highlighting distortions in each area might bring about an improvement in the rehabilitation of such people.

At the chronic stage, severe traumatic brain injured (TBI) patients experience difficulty in making decisions. Several studies have demonstrated the involvement of the prefrontal cortex, in particular the orbitofrontal region, in decision-making. The aim of the present study was to validate a decision-making task in this population and to ascertain whether the components of their dysexecutive syndrome may affect their decision-making and lead to difficulties for social rehabilitation.Fifteen TBI patients and 15 controlled subjects matched for age, sex and years of education were assessed by a battery of executive tests (GREFEX) and by the gambling task (GT).The TBI subjects performed significantly worse than the controlled group in five out of six GREFEX tests. The TBI choices are significantly more disadvantageous than the choices of the control group when considering the three last blocks of 20 cards of the GT. The GT total score correlated significantly with execution time of the Stroop interference condition and the Trail Making Task B, as well as with the two measures (correct sequence span and number of crossed boxes) of the double condition of Baddeley's task.We postulate that executive functioning (supervisory attentional system) influence performance in the gambling task through mechanisms of inhibitory control, divided attention and working memory. Thus, this task seems to be determined by multiple factors; the process of decision-making may depend on frontal integrity.

Many studies have shown that individuals with neurodegenerative diseases are a risk factor for being involved in a traffic accident. However, driving is critical for social integration and independence in daily life. Lack of consensus and standardized assessment of driving abilities in these patients is problematic. This article summarizes the various multidisciplinary evaluations proposed, their limits, and the societal issues raised by such an evaluation. Several neuropsychological theoretical models have attempted to describe the cognitive processes involved in car driving. Moreover, several studies have sought to determine which cognitive functions are impaired in distinct disorders and best explained driving errors. We here describe the relationships between neuropsychological performance and driving abilities for the most frequent neurodegenerative disorders. It appears that a full neuropsychological assessment is necessary to determine accurately which patients are at risk of dangerous driving. In particular, cognitive impairments in attention, visual-spatial abilities, executive functions, and/or information processing speed appear to be the most likely involved in driving errors.

Given the importance of the relationship between executive function (EF) and many aspects of child development - including the development of reasoning, emotion regulation, school performance, and wider self-regulation itself - research on the development of EF from infancy to the end of adolescence has become one of the scientific priorities of the last decade. Improving our knowledge on the maturative trajectory of EF and the functional weight of different internal and environmental factors, supposed to optimize their efficiency, can only promote a better understanding of EF and its role in the normal development of the child as well as of those at risk of poor outcome either because of neurodevelopmental disorders or psychopathological disorders. This article aims to update the recent literature in this area. It appears that executive function grows very gradually and evolves from a relatively simple and unitary model in young children to a more complex one - differentiated, integrated, and tripartite - in adolescence.

Therapeutic education (TE) intends to help patients with systemic lupus erythematosus to better understand their disease and to improve their quality of life. The objective of this study was to assess illness perceptions of the person to provide a motivational environment for TE.Systemic lupus erythematosus patients followed in the department of internal medicine in Lille university hospital responded to a questionnaire assessing five dimensions of the person as proposed by Giordan: the cognitive (knowledge), perceptual (fatigue and pain), affective (anxious and depressive symptoms), infra-cognitive (intimate reasoning) and metacognitive (worldview) dimensions. The quality of life was also evaluated.One hundred and twenty-four patients (114 women (92%); mean age 44.3±14.3 years) responded to the questionnaire. Regarding the cognitive dimension: quantity of information at the time of diagnosis was considered insufficient for 57 patients (46%). The median adherence evaluated by a scale had a median 97mm [88-100]. Regarding the perceptual dimension: pain was assessed at 59mm [44-78] and fatigue at 66mm [50-79] at visual scales. Regarding the affective dimension: prevalence of anxiety symptoms was 67% (83/124) and 28% (35/124) for depressive symptoms. Regarding the infra-cognitive dimension 78 patients (63%) had an external control place. Concerning the metacognitive dimension, systemic lupus erythematosus had repercussions on professional and family life. The quality of life was impacted.Multiple dimensions of systemic lupus erythematosus patient have to be considered for an optimal motivational environment for the practice of TE.

International audience; The current study investigates the specific role of three executive functions in the explanation of performance variability on laboratory and naturalistic time-based prospective memory tasks in aging. Ninety people aged 18 to 80 years performed three executive tasks assessing inhibition, flexibility and updating, one laboratory time-based task and one naturalistic time-based task. The results indicate that age has a negative impact on the laboratory time-based task and a positive impact on the naturalistic task. The mediation analysis shows that inhibition and flexibility operate as a mediator in the negative relationship between age and the laboratory time-based task. Additionally, the hierarchical regression analyses show that, after controlling for age, none of the executive functions evaluated is predictive of performance of the naturalistic time-based task. Overall, these results seem to suggest that different cognitive processes underlie the performance on naturalistic and on laboratory time-based tasks. Future studies should confirm these results.; Cette recherche étudie le rôle spécifique de trois fonctions exécutives dans l’explication des différences de performances à des tâches de mémoire prospective time-based conduites en laboratoire et en milieu naturel au cours du vieillissement. Quatre-vingt-dix adultes âgés de 18 à 80 ans ont effectué trois tâches évaluant l’inhibition, la flexibilité et la mise à jour, une tâche time-based de laboratoire et une tâche time-based naturelle. Les résultats ont montré que l’âge a un effet négatif sur la tâche time-based de laboratoire et un effet positif sur la tâche naturelle. L’inhibition et la flexibilité médiatisent totalement l’effet de l’âge sur la performance à la tâche de laboratoire. Par ailleurs, après contrôle des effets de l’âge, aucune des fonctions exécutives évaluées n’est prédictrice de la performance à la tâche naturelle. Ces résultats semblent suggérer que les performances à des tâches time-based de laboratoire et naturelles pourraient être sous-tendues par des processus cognitifs différents. Des études futures devraient permettre de confirmer ces résultats.

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and adolescents. It is characterized by age-inappropriate inattention/impulsiveness and/or hyperactivity symptoms. ADHD shows a high comorbidity with oppositional defiant disorder (ODD), a disorder that features symptoms of emotional lability. Due to this comorbidity, emotional lability was long considered a secondary consequence of ADHD, which could arise under the influence of environmental factors such as inefficient parenting practices, as part of an ODD diagnosis. In this model of heterotypic continuity, emotional lability was considered not to play any causal role regarding ADHD symptomatology.As opposed to this view, it is now well established that a large number of children with ADHD and without any comorbid disorder exhibit symptoms of emotional lability. Furthermore, recent studies have found that negative emotionality accounts for significant unique variance in ADHD symptom severity, along with motor-perceptual and executive function deficits. Barkley proposed that ADHD is characterized by deficits of executive functions, and that a deficiency in the executive control of emotions is a necessary component of ADHD. According to this theory, the extent to which an individual with ADHD displays a deficiency in behavioral inhibition is the extent to which he or she will automatically display an equivalent degree of deficiency in emotional inhibition. However, not all children with ADHD exhibit symptoms of emotional lability, and studies have found that the association between emotional lability and ADHD was not mediated by executive function or motivational deficits. Task-based and resting state neuroimaging studies have disclosed an altered effective connectivity between regions dedicated to emotional regulation in children with ADHD when compared to typically developing children, notably between the amygdala, the prefrontal cortex, the hippocampus and the ventral striatum. Morphological alterations of the amygdala have also been reported in previous structural studies in children with ADHD.Emotional lability can result from different neurobiological mechanisms. In particular, bottom-up and top-down processes can be opposed. Bottom-up related emotional dysregulation involves an increased emotional reactivity, and is thought to be linked to the automatic evaluative activity of the amygdala. Top-down mechanisms are associated with the regulation of such activity, and rely on a prefrontal network including the lateral prefrontal cortex, the anterior cingulate cortex and the orbitofrontal cortex. Since various neuropsychological impairments and alterations in multiple brain networks have been implicated in the etiology of ADHD, contemporary models emphasize its neuropsychological heterogeneity. It is therefore likely that some but not all children with ADHD will exhibit neurobiological alterations in circuits dedicated to emotional regulation, possibly at different levels. Future research will have to identify the different causal pathways and to decide whether emotional lability represents a criterion to subtype ADHD diagnoses.Emotional dysregulation is now known to play a causal role regarding ADHD symptomatology. Along with executive functioning, reaction time variability and potentially delay aversion, emotional dysregulation should therefore be included in future theoretical models of ADHD, as well as in clinical practice when identifying the major impairments in this diagnostic group and when deciding therapeutic strategies.

Executive function impairments and high level of impulsivity may constitute heritable endophenotypes that confer predisposition for alcohol dependence. Brain volume abnormalities have also been reported in young, alcohol-naïve subjects at high risk (HR) for alcohol dependence, and linked to cognitive dysfunction.This paper presents a literature review of magnetic resonance imaging (MRI) studies that examined brain volumes in adolescent/young adult HR offspring from families with multiple cases of alcohol dependence compared to low risk controls with no family history of alcohol or drug misuse. In some of these studies, executive functioning and externalizing symptoms were also assessed.In HR subjects, local white matter volume deficits were found in the corpus callosum and in the right orbito-frontal cortex, and lower fractional anisotropy in the left inferior longitudinal fasciculus and in the right optic radiation. Altered fronto-cerebellar connectivity has also been reported. Diminished gray matter volume of the cerebellar cortex was found in HR subjects, in the frontal, cyngulate and para-hippocampal gyri, and also in the amygdala, the thalamus and the cerebellum. These structural abnormalities have been associated with higher impulsivity level and executive function impairments, themselves markers of vulnerability to alcoholism. These premorbid cerebral abnormalities may increase the risk for developing an alcohol use disorder in HR subjects through atypical control processing.Brain abnormalities may potentially constitute an abnormal neural network that might underlie the risk towards alcohol dependence. These circuitry abnormalities might contribute to the reward deficiency, as well as impaired response inhibition that predict impulsive spectrum behavior, which are thought to represent the inherited vulnerability to alcohol dependence in HR individuals.

The rate of children born prematurely has increased considerably in the last few decades, and their developmental outcome remains of great concern. The literature on the impact of prematurity has reported a wide range of cognitive and behavioral problems that may be related to deficits in executive function (EF) skills. EF refers to a series of high-level processes (selective attention, inhibition, set shifting, working memory, planning, goal setting) that develop throughout childhood and adolescence and play an important role in cognitive and social development as well as in school achievement. EF skills have been linked to the prefrontal cortex, as well as to other neural networks and brain regions including the basal ganglia and cerebellum. This paper focuses on studies related to the development of EF and social behavior in children born preterm. The preschool period is a critical time to perform neuropsychological assessment in addition to IQ testing, and to detect the child's specific needs in order to adapt effective intervention to enhance the development of executive processes in these high-risk children.

Obesity is currently considered a major public health concern, as shown by the growing number of people with excess weight, alarmingly in infants, and despite medical care. Many studies have underlined the reasons for medical care failure caused by an inability to sustain a resistant behavior towards palatable food (high sugar and fat content). Hence, previous research has highlighted connections between excessive eating behavior and the activity of neurotransmitters in brain areas involved in affective behavior and the reward circuit. Reduction of the dopaminergic activity in the prefrontal orbital and limbic cortex may raise the question of executive skills, which play a major role in social adaptation and behavior control. These findings remind us of the need to grasp environmental and behavioral factors to better identify cognitive and affective profiles and improve childhood obesity treatment.

Alcohol-related cognitive impairments are largely underestimated in clinical practice, even though they could limit the benefit of alcohol treatment and hamper the patient's ability to remain abstinent or to respect his/her therapeutic contract. These neuropsychological deficits can impact the management of patients well before the development of the well-known Korsakoff's syndrome. Indeed, even in the absence of ostensible neurological complications, excessive and chronic alcohol consumption results in damage of brain structure and function. The frontocerebellar circuit and the circuit of Papez, respectively involved in motor and executive abilities and episodic memory, are mainly affected. Those brain dysfunctions are associated with neuropsychological deficits, including deficits of executive functions, episodic memory, social cognition, as well as visuospatial and motor abilities. Such cognitive disorders can interfere with the motivation process to abandon maladjusted drinking behavior in favor of a healthier lifestyle (such as abstinence or controlled alcohol consumption). They can also limit the patient's capacity to fully benefit from treatment (notably psychoeducation and cognitive-behavioural treatments) currently widely proposed in French Addiction departments. In addition, they may contribute to relapse which is multi-determinated. A neuropsychological assessment appears therefore crucial to take relevant clinical decisions. However, very few addiction departments have the human and financial resources to conduct an extensive neuropsychological examination of all patients with alcohol dependence. Some brief screening tools can be used, notably the MOntreal Cognitive Assessment and the Brief Evaluation of Alcohol-Related Neuropsychological Impairments, which has been especially designed to assess cognitive and motor deficits in alcoholism. These tools can be used by non-psychologist clinicians to detect alcohol-related cognitive deficits, which require an extensive cognitive examination conducted by a neuropsychologist. The presence of cognitive dysfunctions in patients early in abstinence should encourage clinicians to adjust the modalities of the treatment. The fact to favor recovery of cognitive functions and brain volumes with abstinence or drastic reduction of alcohol consumption could be a first way to make it possible for patients to be cognitively able to benefit from treatment. Further studies are required to determine whether specifically designed cognitive remediation could boost (accelerate or increase) the recovery of brain functioning. Additionally, a potential effect of thiamine to limit alcohol-related cognitive deficits before the development of neurological complications remains to be determined. In this review, we presented the pattern of structural brain damage and the associated cognitive and motor impairments in alcohol-dependent patients. We then emphasized the harmful effects of neuropsychological deficits in the management of these patients. We also pointed how relevant it is to screen patients with neuropsychological impairments and we focused on the presentation of two brief screening tools for cognitive impairments, especially designed for alcohol-related deficits or not. Finally, we reported how these neuropsychological impairments could be taken into consideration the treatment of alcohol addiction by adjusting its timing and modalities.

The existence of processes common to memory systems and executive functioning was evidenced by studies in the domain of cerebral neuroimaging, individual differences (mainly in normal aging) and, to a lesser extent, neuropsychology. Executive functioning depends on a large antero-posterior brain network, some regions of which (the middle dorsolateral and ventrolateral cortex, the dorsal anterior cingulate cortex) are involved in a series of executive processes, but also in encoding and retrieval of information in episodic memory and short-term memory. A consequence of lesions in frontal areas is to impair strategical organization of the information to-be-processed (an executive process) and thus leads to a lower memory capacity in frontal patients. Moreover, executive abilities will influence both memory efficiency and the associated brain networks even in people without brain pathology. These data attest to the importance of the relationships between executive and memory processes for an optimal cognitive functioning. Recent advances in neuroimaging and electrophysiology data acquisition and analysis techniques should allow us to better determine and understand the fashion in which these relationships work.

Schizophrenia is a complex and heritable disorder. Nevertheless, molecular genetics of schizophrenia remains inconclusive. By developing the concept of endophenotype for the disorder, it is easier to define an association between a phenotype and genetic variants or physiopathological processes. Cognitive disorders could be useful endophenotypes for schizophrenia. For example, the val(158)/met COMT polymorphism has been associated with executive function or working memory. Therefore, several cognitive dysfunctions were proposed as endophenotypes and were investigated in the context of different genetic polymorphisms. Genome-wide association studies and epistatic studies demonstrated the complexity of the mechanisms underlying cognitive disturbance. However, meta-analysis remains inconclusive. Altogether, the study of endophenotypes is an attractive approach to solve the complex mechanisms causing schizophrenia vulnerability. Nevertheless, several limitations exist and include the lack of reproducibility, the discordant results between healthy subjects and patients, the exclusion of the many rare variants.

Cognitive impairment is now well-known in multiple sclerosis (MS). However, few rehabilitation interventions are proposed or really efficient.To present a review of cognitive rehabilitation intervention research conducted in people with multiple sclerosis (MS), regarding different findings about episodic memory, working memory, attention and executive function disorders in MS.A search of Medline (yield 20 papers) and of PsychInfo (yield 1 article), using combinations of the following terms: cognitive rehabilitation, multiple sclerosis, cognitive therapy, neuropsychological rehabilitation, in the title or in the abstract, from 1960 to March 2010, excluding animal studies.Episodic memory rehabilitation studies appear to be promising. Programs on working memory, attention and executive functions are in the very early phases.Results are encouraging and allow specific recommendations for future research about: (1) inclusion criteria, often not defined, (2) a specific baseline adapted to the program of rehabilitation, (3) a control measure regarding program efficiency and (4) a role for the psychologist (presence and advice during the program).

Psychoactive substance consumption induces cognitive impairments in terms of episodic memory and attentional and executive function deficits. This study aims to investigate whether the recall of autobiographical memories is disturbed in substance consumers, and in particular whether those patients tend to evoke memories at a general level rather than at a specific level when confronted by an emotional cue word. Furthermore, we aim to verify whether adopting a more general memory retrieving style is a dynamic phenomenon and if it depends on the type of substance consumed.The participants of this research were 51 cannabis users, including 17 occasional cannabis users, 17 cannabis abusers and 17 individuals addicted to cannabis. They were compared to 18 multiple substance-dependent individuals and to 38 nondependent individuals. Participants were subjected to the Williams and Scott (1988) [39] autobiographical memory test. After an assessment of the mode of substance consumption, several clinical dimensions were measured, such as depression (BDI), anxiety (STAI Y A and B), alexithymia (TAS 20) and episodic memory (RLS-15).The results show that the percentage of general positive and negative memories recalled increases progressively as the consumption takes on the characteristics of addictive behavior, while we observe no deficit in episodic memory. The level of alexithymia evolved in parallel with the percentage of general memories. These results are not dependent on the type of substance used and can not be explained by the level of depression.Overgeneralization is a phenomenon observable in psychoactive substance consumers, whatever the type of substances used, which sets in progressively as the dependence develops. Our results show that overgeneralization is not only due to an impairment of mnesic abilities, implying that this phenomenon could be underlined by several mechanisms. The role of overgeneralization as a functional avoidance established in attempt to protect individuals from emotion resurgence is discussed. Furthermore, the impact of deficits in executive functions on the recall of autobiographical memories in substance abusers has not been studied and would be an interesting path of research.

International audience; Until recently, little was known about destination memory, or memory for the destination of outputted information. In the present work, this memory was evaluated in 32 older adults and 36 younger adults, who had to associate proverbs to pictures of famous people and decide, on a subsequent recognition task, whether they had previously told that proverb to that face or not. When deciding about the destination, participants had to provide contextual judgment, that is, whether each picture had been previously exposed in color or in black and white. Participants also performed a neuropsychological battery tapping episodic memory and executive functions. Findings showed poor destination recall in older participants. Destination recall in older adults was reliably predicted by with their context recall. Destination memory seems to be particularly affected by aging, a deterioration that can be related to deficits in processing contextual features during encoding.

Given the extent, magnitude and functional significance of the neurocognitive deficits of schizophrenia, growing attention has been paid recently to patients' self-awareness of their own deficits. Thus far, the literature has shown either that patients fail to recognize their cognitive deficits or that the association between subjective and objective cognition is weak in schizophrenia. The reasons for this lack of consistency remain unexplained but may have to do, among others, with the influence of potential confounding clinical variables and the choice of the scale used to measure self-awareness of cognitive deficits. In the current study, we sought to examine the relationships between subjective and objective cognitive performance in schizophrenia, while controlling for the influence of sociodemographic and psychiatric variables.Eighty-two patients with a schizophrenia-spectrum disorder (DSM-IV criteria) were recruited. Patients' subjective cognitive complaints were evaluated with the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS), the most frequently used scale to measure self-awareness of cognitive deficits in schizophrenia. Neurocognition was evaluated with working memory, planning and visual learning tasks taken from Cambridge Neuropsychological Tests Automated Battery. The Stroop Color-Word test was also administered. Psychiatric symptoms were evaluated with the Positive and Negative Syndrome Scale and the Calgary Depression Scale for Schizophrenia. The relationships between subjective and objective cognition were evaluated with multivariate hierarchic linear regression analyses, taking into consideration potential confounders such as sociodemographic and psychiatric variables. Finally, a factor analysis of the SSTICS was performed.For the SSTICS total score, the regression analysis produced a model including two predictors, namely visual learning and Stoop interference performance, explaining a moderate portion of the variance. Visual learning performance was the most consistent predictor of most SSTICS subscores (e.g. episodic memory, attention, executive functioning, language and praxis). Modest associations were found between the PANSS cognitive factor and objective cognition (e.g. Stroop interference, visual learning, and working memory). Finally, the factor analysis revealed a 6-factor solution that echoes the classification of the items of the SSTICS based on the neuropsychological literature.Using a scale having good internal validity, as shown by the factor analysis, the current study highlighted modest associations between subjective and objective cognitive performance, which suggests that schizophrenia patients are only partially aware of their own cognitive deficits. The results also showed a lack of correspondence between the impaired cognitive domain and the domain of cognitive awareness. It should be noted that clinicians were not better than patients at evaluating their cognitive deficits. Future research will need to determine if the observations reported here are schizophrenia-specific or not.

Various studies highlight cognitive impairments in cancer patients. This paper proposes a review of longitudinal controlled studies evaluating the efficacy of interventions aiming to reduce these cognitive impairments. Longitudinal controlled studies evaluating the efficacy of interventions aiming to reduce cognitive impairments in adult cancer patients and published between 1993 and 2013 were identified, with the exception of studies that implied patients suffering from CNS tumor or metastasis. Pharmacological interventions (n = 11) suggested the positive impact of modafinil on memory and executive functions. Non-pharmacological interventions (n = 10) suggested the positive impact of cognitive revalidation and stimulation programs, psycho-education and meditation on several memory, attentional and executive objective as well as subjective functions. Non-pharmacological interventions show more significant cognitive benefits than pharmacological interventions. Some longitudinal controlled studies support the usefulness of interventions aiming to reduce cognitive impairments in cancer patients. Further studies should evaluate the effectiveness of programs combining technics aiming to reduce cognitive impairments and psychotherapeutic technics aiming to support patients' coping with illness.

Early impairment of the cognitive and behavioral executive processes are found in Mild Cognitive Impairment (MCI) as well as in Alzheimer's disease (AD). These processes are strongly linked to autonomy in daily living because they are involved in our adaptation to many new situations.To evaluate the executive processes and their links with autonomy, we compared 20 control subjects to 20 patients with MCI, and 20 patients with early AD. All participants completed three executive cognitive task, according to the Miyake's model: set-shifting was assessed by the Trail Making Task, inhibition control by the Hayling test, and working memory by the Updating test. They also completed the Lille Apathy Rating Scale (Lars) evaluating four components of apathy. The autonomy, conceptualized as competency in four domains of daily-living, was evaluated by the Patient Competency Rating Scale (PCRS), completed by a close relative.Control subjects showed higher scores than both clinical groups on the TMT time completion. AD group showed a tendency to make more errors than the control subjects on Hayling test, whereas MCI group didn't differ from the other groups. No other group effect was found on the executive dependent variables. Both MCI and Alzheimer groups had higher scores of apathy than the control group on the Lars total score and its three components. Similar results were found on the PCRS and the Lars three subscales. The best predictors of autonomy were the TMT time completion and the total Lars score.Loss of competency is found in MCI as well as in AD and is correlate to set-shifting and apathy.

Neurocognitive dysfunction is increasingly recognized as a prominent feature of bipolar disorder. Cognitive function seems to be impaired across different states of bipolar illness. Nervertheless, research that studies neuropsychological functioning in acute phases is scarce. Acutely ill patients have shown dysfunctions in several cognitive areas. We reviewed the literature on neuropsychological studies of acute phases to highlight neurocognitive deficits in mixed and pure mania. The results show dysfunctions in sustained attention that are significantly more important in mixed mania rather than in pure mania. Impulsive pattern of responding seems to characterize pure manic state. We also found impairments in processing speed, verbal and spatial learning/memory and executive functions, including cognitive flexibility, inhibitory control, conceptual reasoning, planning and problem solving. Disturbance in executive functioning seems to be more important in pure mania rather than mixed mania.

This study highlights the incongruence of geriatric institutions to set up activities for elderly people without taking into account the circadian fluctuations of cognitive processes related to circadian rhythms. By example, rehabilitation for falls is based on the indication given by the therapist (instruction), its integration and assimilation by the patient (comprehension), and the resulting action (execution). However, the recorded information and the execution may present a shift of phase and even an opposition of phase. The Test of Folding a Rhombus (TFR) was conceived to assess the fluctuation and articulation of these processes. It was proposed to 60 elderly individuals divided into 2 groups (30 subjects with cognitive disorders - case group - and 30 subjects without cognitive disturbance - control group -), and was applied at different time schedules of the day (8:00, 11:00, 15:00 and 18:00 h) once a week during 4 weeks. Its purpose was to quantify the relationship between automatic and controlled processes. Statistical analysis indicates significant circadian differences during the evolution of the two processes between the case and control groups. Simple, fast and easy to use, the TFR can also help professionals to choose the best automatic or controlled processes activity according to the need of patients.

Persistent cognitive deficits in euthymic bipolar patients are now well documented. Indeed, several studies and meta-analyzes clearly establish the existence of cognitive deficits in specific domains: attention (in particular sustained attention), Memory (in particular verbal memory) and executive functions. The impact of cognitive deficits on patient's functioning is also well documented and their role appear to be more important than expected by comparison with the impairment related to thymic residual symptoms. The development of specific cognitive remediation strategies is therefore a major hope for improving the quality of remission and functional outcome. The aetiology of these deficits remains poorly understood. However, the implication of factors related to the biological/genetic vulnerability to bipolar disorder is likely well as a "neurotoxic" effects of major mood episodes, in particular acute manic episodes that seems to play a important role in the worsening of these deficits over time. This further stresses the importance maintenance strategies for long-term functional outcome.

The incidence of brain metastases (BM) has increased due to the improvement of therapeutics and diagnostic imaging, but also to an aging population. The initial symptoms may develop suddenly or insidiously over weeks or months. The symptoms depend on the location of the BM and related complications (hydrocephalus, tumor hemorrhage, cerebral herniation). Headaches are the most frequent symptoms (50%); they are related to intracranial hypertension. Cognitive deficits are commonly described at diagnosis (67 to 90.5%). Cognitive assessment is essential because of its impact on patients' prognosis and quality of life. Nevertheless, these deficits remain underestimated. The Karnofsky Perfomance Scale and the Mini Mental State Examination (MMSE) seem inadequate. A short battery was proposed and internationally validated, assessing seven domains: attention (Digit Symbol Test WAIS-III), episodic memory (Hopkins Verbal Learning Test [HVLT]), working memory (Digit Span Test WAIS-III), verbal fluency (Controlled Oral Word Association Test [COWA]), fine motor dexterity (Grooved Pegboard Test), information processing speed (Trail Making Test [TMT] A) and executive functions (TMT B). This battery is relevant, feasible and associated with a good compliance. These cognitive tests are currently recommended to assess cognitive functions in patients with BM.

Teenagers and adults with intellectual disabilities are nowadays "over-handicapped", often due to lack of care in self-sufficiency and continued learning, two essential domains for living in a community. Their cognitive limits, particularly on the executive functions, could be an obstacle to their involvement in the daily life activities, through their difficulties to plan, anticipate, shift and maintain information in working memory. These high level mental functions can be taught with the CRT program (Cognitive Remediation Therapy - Wykes and Reader 2005) developed in other pathologies and providing an adaptation regarding the developmental level of the person.Firstly, it is essential to determine cognitive developmental levels of the teenager or the adult, using standard tools, such as Wechsler scales. Secondly, functional and/or adaptative levels have to be assessed using specific tools, such as the Vineland Adaptative Behavior Scale 2nd Edition (VABS-II, Sparrow et al., 2005) and the Functional Intervention Scale (EFI, Willaye et al., 2005). Finally, in order to clearly distinguish what are the preserved and impaired cognitive domains, standard tools assessing executive functions such as the Wisconsin Card Sorting Test, the Tower of London, Stroop Test and BADS are used if possible for the patient. The setting of cognitive remediation programs, previously developed for schizophrenic patients, requires adaptation for teenagers and adults with intellectual disabilities, taking into account the limitation of their cognitive abilities. In this paper, we will show that the CRT method for cognitive remediation is particularly relevant for subjects with intellectual disabilities. This method is hence focused on strategies and exercises to improve working memory, categorization and moreover executive functions. Of course this method might need adaptations, with examples based on simplification of the different tasks, notably for verbal materials, and with variations of the media used. These sessions will be part of a wider individualized caring project, allowing the person to transfer the cognitive acquisitions to his/her daily life.The use of cognitive programs adapted to people with intellectual disabilities can provide benefits in the development of autonomy and daily life activities, leading to a better quality of life and self-esteem.

Schizophrenia is a complex illness whose mechanisms are still largely unknown. Functional brain imaging, by making the link between psyche and brain, has recently become an indispensable tool to study in vivo the neural bases underlying cognitive dysfunction in this disease. But despite the proliferation of data coming from this approach, the exact impact of functional imaging on our understanding of the disease remains blurry. In general, studies of the brain functioning of patients with schizophrenia found activation abnormalities which vary in nature and localization depending of the cognitive paradigm used. However, it appears that neurofunctional abnormalities observed in patients cannot be reduced to a simple well-localized deficit. It would be rather an alteration of the dynamics of the interactions between different brain regions that underlie the cognitive disturbances encountered in the disease. Functional brain imaging now offers new perspectives to clarify the dynamics of the brain networks, and particularly those involved in high-level cognitive functions, such as cognitive control or social cognition which seem to play a crucial role in the disease. The characterization of these features is an important issue not only to develop new hypotheses on the pathophysiology of the disorder, but also more pragmatically to identify potential therapeutic targets.

Schizophrenia affects 1% of the general population. In addition to disabling clinical symptoms, cognitive deficits have also been updated. It has further been proposed that the well-known diversity of schizophrenia in terms of functional outcome and recovery from acute episode is best characterized by cognitive deficits, but not by its classical symptoms. DSM-V acknowledges the importance of cognition in schizophrenia, and could recommend a formal neuropsychological assessment in individuals with psychosis. Schizophrenic patient's cognitive functioning has been studied extensively in the domain of memory and executive control. To date, the studies highlight important deficits in both of these domains. However, within the memory systems, some of them remain unaffected. Altogether, the data invalidate the hypothesis of a global damage and are in favor of specific cognitive deficits. The observed deficits would depend on the dominant symptoms and pre-morbid functioning. The interest of these results was to give impulse to the development of comprehensive assessment battery designed to evaluate the cognitive profiles of each patient and develop a personalized program of cognitive remediation.

The aim of this review of the literature is to summarise the definitions of metacognition, the measurement tools, the results of studies investigating metacognition in persons with schizophrenia and the therapeutic perspectives.This review is based upon a selection of articles identified using a PubMed search containing the terms "schizophrenia" and "metacognition".Cognitive deficits are present in 75 to 85% of persons with schizophrenia. According to the disability model of the World Health Organization, these cognitive deficits have an impact on social functioning, community integration and quality of life. However, heterogeneous results have been obtained by studies exploring the functional impact of cognitive deficits, suggesting that there is no direct relationship between these two characteristics. One possible explanation is that subjective factors, notably metacognition, may play an intermediate role moderating the link between cognitive deficits and functional impairment. Metacognition is defined as the evaluation and regulation of its own cognitive processes. The evaluation (or monitoring) monitors the accuracy and reliability of the cognitive task performance. Regulation (or control) promotes behavioural adjustment. Studies carried out in persons with schizophrenia show that most of them experience deficits in metacognitive performance. These metacognitive deficits are thought to be a key barrier to functioning in schizophrenia. Measurement tools are classified into two types: "independent" measurement of the cognitive task and "on line" measurements performed during the cognitive task. The subjective scale to investigate cognition in schizophrenia (SSTIC) and the metacognitive assessment scale (MAS) are two examples of questionnaires measuring metacognition independently of the cognitive task. Online measurements assess the metacognitive "monitoring" by asking the subject to evaluate between 0 and 100% of his/her degree of confidence in his/her response to a question. The metacognitive "control" is assessed by asking the subject to validate his/her answer. Convergent findings are reported by studies exploring metacognitive persons in people with schizophrenia. Dissociation between metacognitive monitoring and metacognitive control has been reported. Regarding metamemory, which has been currently the most studied area, no difference is observed between persons with schizophrenia and controls with respect to the metamemory judgement. However, subgroups of persons with schizophrenia differ significantly from controls: they are over-confident in their response if it is incorrect and they estimate more frequently than the controls if they do not know when their answer is correct. The relationships between metacognitive and cognitive deficits are complex in persons with schizophrenia, with poor matching between subjective and objective deficits. Several studies have reported that metacognitive difficulties strongly interfere with social functioning. It has been suggested that metacognitive deficits more strongly predict community functioning in persons with schizophrenia than cognitive deficits. Metacognitive skills may hence be viewed as a key factor in translating cognitive performance skills in daily life.These data suggest that remediation programs specifically targeting metacognitive deficits have to be further developed.

The nature of neuropsychological mechanisms underlying the clinical picture of obsessions and compulsions has not been clearly determined. A number of studies has emphasized the role of cognitive deficits, but diversity of methodology and overlapping of clinical sub-groups have not established a specific cognitive functioning of these patients. The studies carried out on executive functions have, however, helped to identify the important role that both inhibition and cognitive flexibility play in obsessive-compulsive (OC) symptoms. Most of them have found that a deficit of inhibition and alteration of cognitive flexibility could explain inflexibility and repetitive thoughts and actions typical of all types of OC disorders. The aim of the paper is to present the published data supporting the hypothesis of a specific role played by a deficit of inhibition and cognitive inflexibility. In the first, theoretical part, we present the neuropsychological approach emphasizing inhibition and lack of flexibility as a promising explanation of the functioning of OC disorders. In the second part, we will present studies using various measurements of inhibition and the results of which, therefore, support this hypothesis.On the theoretical level, it is the model of attention that was used in explaining the OCD hypothesis. In the model of attention control of action, described by Norman, Shallice and Burgess, three systems were emphasized: one that takes care of routine actions, and the second that takes over the first in situations where automatic activities must stop in order to establish an attention control and therefore inhibit automatic responses. When selection of everyday and automatic activities is not sufficient to accomplish a task, it is the third system, that of cognitive control, which takes over. This supervisory attentional system operates in non-routine and ambiguous activities. The cognitive control is charged with detecting potential or emitted cognitive errors and resolving ambiguous situations. Neurocognitive studies show that cingular anterior cortex and prefrontal lateral cortex are engaged in ambiguous and conflicting situations. These two regions are considered essential for inhibition of routine actions, adjustment to change and, more generally, for an efficient and flexible behaviour. Repetitive nature of verification rituals in OCD could be explained in terms of lack of relationship between two systems, leaving in action the one that regulates automatic activities. Therefore, the rituals are considered to be under particular influence of the system which, being in charge of automatic actions, has a deficit in disengagement. Another model of attention, described by Posner, gives a further explanation of OCD. Mental inhibition has the capacity to treat information, either by applying strategies to control it (i.e. trying not to remember an unpleasant event) or leaving it to automatic control (i.e. incapacity to experience an emotion in relation to a particular event). In this way, the effort to suppress an intrusive thought is considered as controlled and deliberate cognitive treatment of emotionally charged information. In OCD, in the context of heightened anxiety, the assumed negative valence of information would influence habitual suppression of thought during controlled treatment. As a result, controlled efforts to suppress obsessions in emotionally stressful situations, would lead to the production of repetitive thoughts, as controlled treatment of information has failed in this action. On a clinical and experimental level, these studies have led to a better understanding and conceptualization of OCD. In spite of some conflicting results, there are concordant data in favour of hypotheses of the role of sub-cortical and frontal regions and their function in inhibition/desinhibition implied in the onset and maintenance of OCD. Functional neuroimagery anomalies are also in favour of the role of sub-cortical-frontal region in clinical manifestations of OCD. They are often associated with low performance in cognitive tasks, especially those implying frontal functions, which are, in turn, dependent on a necessary level of attention in order to guide or inhibit motor and cognitive programs.

Borderline personality disorder (BPD) is a complex psychopathology. Through recent developments, neuroscience is able to contribute to better understanding the neurobiological underpinnings of BPD manifestations. This article aims to demonstrate that BPD is in part due to executive and frontal dysregulation of the mechanisms responsible for the optimal functioning of inferences specific to theory of mind. To do so, four types of observations will be examined: parallels between frontal personality and BPD, the presence of frontal cognitive deficits in BPD, the consequences of childhood abuse and neglect on brain development and finally, the results of brain imagery in BPD. This article follows in the path of a growing interest in the integration of the neuroscientific perspective of BPD to current conceptualisations in psychopathology. The final aim is to try to offer an understanding of BPD manifestations that avoids the traditional splitting between mind and brain-psychology and biology-and to show the numerous associations between clinical psychology and neurobiology.

We have examined and diagnosed confabulation in a 20-year-old woman who had suffered severe traumatic brain injury (TBI) when she was 12. Spontaneous confabulations were associated with dysexecutive behavior involving perseveration and impulsiveness. The patient was amnesic during neuropsychological tests but did not present intrusion, confabulation or false recognition. She could evoke self-constitutive autobiographical events accurately and without fantasizing. The only difference between her false and true recollections is that the patient could never envision herself as an actor in a scene involving confabulation. She succeeded, albeit slowly, in carrying out the classic executive tests: Stroop, Trail Making A and B and Wisconsin Card Sorting (WCST). She showed particularly slow reaction time and was impulsive and hurried in her performance of the D2 attention test, the errands (Martin) test and the chocolate cake test. Her working memory was significantly impaired. A peculiar inability to inhibit the generation of fictional constructions may reflect a problem in control of short-term memory. Diagnosis of the confabulation phenomenon has had three clinical consequences: 1) information has been given to the patient, her family and other people close to her; 2) reeducation by means of voluntary memory control prior to speaking has been proposed; 3) reporting on the case has been improved.

Impairment of working memory (WM) is frequently reported in multiple sclerosis (MS) patients. However, the various methodologies used, as well as the populations selected for study, hinder the interpretation of results. The aim of this study is to propose a review about WM in MS.Twenty studies have presented results on WM with neuropsychological assessment.All studies conclude that WM is impaired in MS. Reduced processing speed would be central, with major impact on WM performance. According to Baddeley's model, difficulties may be located at the level of the central executive. MS patients would be sensitive to tasks with a high cognitive load. However, performances seem to become better when the processing speed is adapted. Explanatory models relating to this kind of impairment have been proposed from imaging studies. Compensation could mask deficits in WM at the early stage of the disease, but would become blurred with advancing illness and increasing load required for the task. CONCLUSIONS/PROSPECTS: In order to assess WM, adapted tools should be proposed to MS patients. Focus should be placed on processing speed. Further studies are needed, for instance to examine the dissociation of the processes operating within the central executive as described in Miyake's model. Imaging investigations have provided essential data helpful for understanding compensation mechanisms. These data should be useful for developing adapted remediation plans to compensate for the crippling impairment observed in everyday life.

Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood. Although some symptoms of ADHD may diminish this does not mean that functioning is unimpaired in adults. Follow-up studies of children with ADHD show that it persists into adulthood in the majority of cases. Due to genetic factors high rates of ADHD exist among the parents of children with ADHD. More females are identified and become diagnosed in adulthood. There is a greater persistence of inattentive than of hyperactive/impulsive childhood symptoms of ADHD in adulthood. Some experts conceptualise ADHD as primarily a deficit of executive functions impairing planification, time perception and emotional regulation. ADHD often presents as a lifelong condition in adults associated with a range of clinical and psychosocial impairments. Young adults with comorbid antisocial or substance use disorder in adolescence are at significantly increased risk for criminal behaviors. Some predictors of the outcome have been identified such as childhood symptom profile and severity, comorbidity and childhood family adversities.

The questionnaire DEX was designed by Wilson et al. in 1996 to explore the disturbances of executive functions (EF) in activities of daily living (ADL).This study was performed to explore the specificity of the DEX to evaluate executive dysfunction in ADL, and its contribution to the distinction between Alzheimer's disease (AD) and frontotemporal dementia (FTD).13 patients with the frontal variant of FTD, 19 patients with FTD associated with amyotrophic lateral sclerosis, FTD/SLA, 18 patients with Alzheimer's disease, AD, and 24 controlled subjects.The scores on the DEX completed by a proxy as well as those on two scales assessing ADL (the Cognitive Difficulties Scale by McNairKahn, and a composite scale (NADL) including the evaluation of basic (BADL) and instrumental (IADL) by the LawtonBrody scales, and of social activities (SADL) from KatzLyerly) were compared to neuropsychological tests assessing EF (Behavioural Assessment of Dysexecutive Syndrome (BADS), Wisconsin Card Sorting Test, Stroop test, Trail Making Test B, lexical and categorical verbal fluencies, WAIS-III similarities).No correlation was found between the scores on the DEX or the other ADL scales, and the BADS scores. Scores on DEX showed some weak correlations with some executive tasks, but no stronger than those found with the other ADL scales. Analysis of the most frequently perturbed DEX items failed to show a characteristic profile for EF dysfunction. No significant difference was found between patients with AD and DFT on the scores on the DEX as well as on other ADL scales, when adjusted for dementia severity (assessed by the Mattis Dementia Rating Scale (MDRS)). No difference was found between MA and DFT patients neither in the profile of the most frequently perturbed DEX items, nor in decreased awareness of the disorders assessed by comparison of the scores on the DEX completed by patients and familiars.In this study, DEX does not appear as a specific tool for assessing EF dysfunction in ADL compared to other ADL scales. It was more related to global cognitive difficulties as assessed by the CDS and the MDRS. Scores on the DEX as well as on other ADL scales do not contribute to the distinction between AD and FTD.

Numerous decision-making situations occur in the activities of daily living. The consequences of the decision-making capacity disturbances may have a great impact on the patient's autonomy, financial management, and his or her reaction to a diagnosis as well as the ability to accept a therapeutic option or give informed consent. Decision-making is a complex and multi-dimensional process and brings into play attention, memory and executive functions, which are processed in the prefrontal cortex, particularly vulnerable in aging. A better comprehension of the mechanisms of decision-making, and of the resulting social consequences of their dysfunction may improve autonomy of the elderly. Unfortunately, we still lack appropriate tools to explore decision-making in routine practice.

The deficits of recognition of facial emotions and attribution of mental states are now well-documented in schizophrenic patients. However, we don't clearly know about the link between these two complex cognitive functions, especially in schizophrenia. In this study, we attempted to test the link between the recognition of facial emotions and the capacities of mentalization, notably the attribution of beliefs, in health and schizophrenic participants. We supposed that the level of performance of recognition of facial emotions, compared to the working memory and executive functioning, was the best predictor of the capacities to attribute a belief.Twenty schizophrenic participants according to DSM-IVTR (mean age: 35.9 years, S.D. 9.07; mean education level: 11.15 years, S.D. 2.58) clinically stabilized, receiving neuroleptic or antipsychotic medication participated in the study. They were matched on age (mean age: 36.3 years, S.D. 10.9) and educational level (mean educational level: 12.10, S.D. 2.25) with 30 matched healthy participants. All the participants were evaluated with a pool of tasks testing the recognition of facial emotions (the faces of Baron-Cohen), the attribution of beliefs (two stories of first order and two stories of second order), the working memory (the digit span of the WAIS-III and the Corsi test) and the executive functioning (Trail Making Test A et B, Wisconsin Card Sorting Test brief version).Comparing schizophrenic and healthy participants, our results confirmed a difference between the performances of the recognition of facial emotions and those of the attribution of beliefs. The result of the simple linear regression showed that the recognition of facial emotions, compared to the performances of working memory and executive functioning, was the best predictor of the performances in the theory of mind stories.Our results confirmed, in a sample of schizophrenic patients, the deficits in the recognition of facial emotions and in the attribution of mental states. Our new result concerned the demonstration that the performances in the recognition of facial emotions are the best predictor of the performances in the attribution of beliefs. With Marshall et al.'s model on empathy, we can explain this link between the recognition of facial emotions and the comprehension of beliefs.

Attention-deficit hyperactivity disorder (ADHD) is a heterogeneous disorder currently defined by clinical history and behavioral report of impairment. The Attention Network test (ANT) gives measures of different aspects of the complex process of attention.We ask if children with Attention Deficit Hyperactivity Disorder (ADHD) will show a characteristic pattern of deficits on this test.The sample included 40 children (M=9 years) who performed the "Attention network test". Children with an ADHD diagnosis (N=20) were compared to a control group (N=20).The group of children with ADHD showed slower reaction times in all conditions (mean RT=866 ms; SD=234,063). Children with ADHD showed a significant impairment in their executive control system compared to healthy subjects, with slower reaction times in incongruent conditions and lower accuracy scores (RT=1064 ms; F(1.38) p=0.02). Our results showed that spatial orienting and alerting in ADHD was no different than controls (p=0,68). ADHD group showed a greater variable response (p=0,0001).The present study showed that impairment in executive control system and variability measures are the characteristic pattern of deficits in children with ADHD.

In France, attention deficit disorder (ADHD) has traditionally met with two opposing approaches (biological and psychoanalytic). This conflict led us to conduct a multidisciplinary observational study, on a group of 36 children over a period of 1 year.Thirty-six children with ADHD diagnostic (DSM IV), not treated by MPH were included. Initial "multi-field" evaluation (T0) consisted of: neuro-paediatric consultation (Conners questionnaire, Child Behaviour Checklist, reading and writing scores by French tests); semi-structured child psychiatric interview (DSM-IV axis I), structural hypothesis (CFTMEA), existence of narcissistic fragility, parents/child interactions; neuropsychological standardized evaluation (attention and executive functions); psychodynamic interview and projective tests (Rorscharch, CAT or TAT). A therapeutic project is proposed combining MPH and psychotherapy according to the results. A new evaluation 1 year later (T1) included a consultation and a neuropsychological evaluation. RESULTS T0: All parental questionnaires appreciating attention deficit and hyperactivity/impulsivity were significantly pathological. The neuropsychological evaluation showed usual characteristics of ADHD with individual differences. The psychiatric evaluation revealed the frequency of comorbidity in axis I (23% of children with more than two diagnoses, 57% with anxiety disorder, 23 and 3% with oppositional and conduct disorder). FOLLOW UP (T1): Thirty-one children were re-examined (20 treated by MPH and 11 not treated because of parental refusal or particular psychopathological situations). Psychoanalytical psychotherapy, proposed to 28 children, was undertaken with only 19. An improvement in scores for attention and executive tests was registered only in the treated group.The tests confirm deficits of attention and executive functions without correlation with the scores of questionnaires, underlining the need for a neuropsychological evaluation to objectify attention disorders. Projective tests refine and enrich psychiatric evaluation and showed that half of the children had borderline organization. However, structural hypotheses were heterogeneous, suggesting the need for specific therapeutic projects to be devised according to each child. The treated children were the only ones to improve attention deficit. On the other hand, the scores of anxiety are not improved by MPH, emphasizing the indications of psychotherapy if comorbidity is present. Psychotherapeutic care was carried out only among part of the population, because of parental reservations, exacerbated by differences of opinion among professionals and lack of access.This study is innovative, providing precise data on ADHD from a multidisciplinary perspective. Psychopathological comorbidity is high in this population, so the concept of ADHD cannot be limited to a cognitive point of view. These elements and doubts regarding the efficacy of behavioural therapies suggest the need for a rigorous evaluation of analytical psychotherapies independent of MPH to treat attention deficit.

In schizophrenia, alteration in the prefrontal cortex can induce some deficiencies of the executive functions, and among them errors in inhibition of prepotent responses. This type of inhibitory processes was called "restraint function" by Hasher et al. It implies a conscious and voluntary inhibition which demands attentional resources. Among the tasks exploring this function, the Hayling completion sentence task (Burgess and Shallice) appears to be the most specific. Moreover, healthy subjects performing this task in functional magnetic resonance imaging (fMRI) show activation of the prefrontal cortex. In this study, we investigated inhibitory processes in schizophrenic patients using two versions of the Hayling completion sentence task, a behavioural version and an fMRI version in order to assess both performance levels and brain correlates of inhibitory processes.Forty-eight schizophrenic participants according to DSM-IV, (mean age: 32.8, S.D. 7.7), stabilized for at least one month, receiving antipsychotic medication and with IQ higher than 70 (mean: 96.86, S.D. 20.67) and education level (mean: 11.15, S.D. 3.26) participated in the behavioural study. They were matched on age (mean: 33.8, S.D. 7.6) and education level (mean: 12.28, S.D. 2.87) with thirty-two healthy controls. Nineteen of schizophrenic participants (mean age: 33, S.D. 6.9 and IQ: 99, S.D. 10.74) were assessed by an fMRI adaptation of the Hayling task, matched with 12 controls (mean: 33.9, S.D. 7.3). All the participants had to perform the Hayling task and a speed accuracy task. The Hayling task consists in sentences for which the last word is missing. In the initiation condition, the participants had to complete the sentence with the appropriate word, whereas in inhibition condition the participants had to complete the sentence with inappropriate and unrelated words.Compared to controls, schizophrenics showed an increased number of errors in the inhibition of prepotent responses associated with increased reaction times, even when considering information processing speed. fMRI results showed fairly similar frontal activations in both groups. Nevertheless, schizophrenic patients presented principally large activations in dorsolateral and ventrolateral frontal cortex, the superior frontal sulcus, the frontal pole and the premotor cortex, and stronger activations (bilateral) in the posterior parietal cortex. Control subjects demonstrated a network of deactivated brain regions whereas the schizophrenics did not.Our results are in favour of poorer efficacy of restraint function, sometimes comprising impairment of inhibitory processes inducing errors in schizophrenics. This deficiency might be considered as insufficiency in attentional resources and/or in working memory. Hence patients cannot simultaneously restrain prepotent response and find appropriate controlled strategy for correct completion of the task. Moreover, bilateral patterns of parietal hyperactivation and absence of patterns of deactivation seem also in favour of an attentional hypothesis. The Hayling task might be interesting for assessment of inhibitory processes in schizophrenia.

The aim of the present study was to compare and contrast developmental dyspraxia and dyspraxia following preterm birth.Three different domains (attention-executive function, sensorimotor and visuospatial functions) were evaluated using Nepsy battery tests and the Purdue pegboard test.The results of a neuropsychological evaluation of 32 children with developmental dyspraxia (the DVLT group) were compared with those of 16 children with dyspraxia following preterm birth (the AP group). The population inclusion and exclusion criteria were set according to Gérard's (Gérard C-L. Le concept de dyspraxie. In: Gérard C-L, Brun V, editors. Les dyspraxies de l'enfant. Paris: Masson; 2005. p. 15-24.) definition of dyspraxia.The two groups had similar visuospatial performance. However, differences between the DVLT and AP children appeared in a test of attention-executive function (visual attention, specifically) and in some sensorimotor tests, with better performance by the DVLT group in all situations.The difficulties exhibited by preterm-born children (poor upper limb motor control, more severe dyspraxia and the presence of oculomotor impairments) could explain the latter's poor performance relative to children with developmental dyspraxia. Indeed, oculomotor impairments are especially likely to impair performance in visual attention and visuomotor accurary tests - the two situations in which preterm-born children performed worse.

This study's first objective was to confirm that patients with schizophrenia and their nonmentally ill siblings share the same impaired executive function when compared to healthy control subjects. The second objective was to study the relation between Wisconsin card sorting task (WCST) performance and the persistence and severity of clinical symptoms, as well as different clinical dimensions.Ninety subjects were involved in this study, divided in 3 groups of 30 each: one group of patients with schizophrenia, one group of their siblings, and a control group. Symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS), and social functioning was measured by the Global functioning scale (GFS). The WCST was administered to all 3 groups.Patients with schizophrenia and their siblings had a significantly lower WCST performance than control subjects. Statistical analysis showed that the patient group had a significantly greater impaired WCST performance than the 2 other groups. Siblings also had a significantly lower performance than the control subjects. Furthermore, no significant relation was found between WCST performance and other variables, including age, gender, education, illness duration, treatment, and different PANSS and GFS scores.Patients with schizophrenia and their nonmentally ill siblings share the same impaired executive function. These findings suggest that WCST performance can be considered a schizophrenia vulnerability marker in siblings of patients with schizophrenia.

The rehabilitation of executive function disorders, mainly observable after a stroke or head injury, requires new TPE solutions. Patients are no longer able to articulate actions or thoughts directed toward a final goal, they are no longer autonomous and their anosognosia severely limits their involvement. Our methodology of Serious Game Design within a Research and Intervention approach in a health establishment allowed us to co-construct a therapeutic device in a dynamic way. The scenario considers learning mechanisms, metacognition, motivation and commitment. Correctly carried out, this work can improve learning and transfer to real life. To arrive at concrete perspectives, we considered representations linked to the dynamics of the lived situation, constructed in the course of action.The scenario thus contains a meaningful experience by emphasizing curiosity with exploratory behavior. Its theme, its interactive narration, its game elements, its mechanics to de-dramatize error and promote relative self-determination, its characters for the implementation of the theory of mind, its metaphors of interactions through direct actions, the facilitating and inclusive medium or its feed-back are all designed to put the patient back at the heart of the ETP, the real actor of his rehabilitation in order to help him become aware of his disorders and to develop his own strategies in order to regain his autonomy.

In French language, there is no standardized procedure to assess cognitive function in patients with multiple sclerosis (MS). Such an assessment is however very useful to determine the consequences of the disease on cognitive function, to evaluate the disease progression and the consequences of usual treatments on cognition. This study aimed to develop and validate a French language battery based on "the Brief Repeatable Battery of Neuropsychological tests for Multiple Sclerosis" (BRB-N) often used in other countries. In an initial phase, the battery was composed of the French version of the 5 BRB-N tests to which were added 4 tests assessing immediate and working memory as well as executive function. 52 healthy control subjects (20-50 years) participated in the study. A principal component analysis (PCA) of their data examined the contribution of each test into the battery. 93 other healthy subjects participated in a second phase where analyses of variance were carried out to investigate the effect of the main demographical variables. Finally, the performance of two patient groups (20 with a EDSS scoreor=3 et 31 with a EDSS score3) was compared to the healthy controls in order to investigate the ability of our battery to detect cognitive impairment in MS patients. The PCA showed that each test, except one, had a specific contribution to the battery. The final battery (BCcogSEP) was thus comprised of 8 tests. MANOVA and ANOVA showed significant effects of age, sex and educational level on performance. In consequence, a procedure allowing to take into account these factors was developed. The battery was able to detect cognitive impairment in MS patients, even when the disease is not severe. In this case, deficits were observed in tests assessing executive function, information processing speed, immediate and working memory. This short battery with reliable psychometric qualities allows the interpretation of a MS patient's performance considering his/her demographical characteristics and is able to detect cognitive abnormalities even in case of mild physical handicap.

Inattention, excessive motor activity and impulsivity observed in children with attention deficit hyperactivity disorder (ADHD) are presently considered as an executive function deficit. Certain authors suggest that children with ADHD, combined and inattentive types, present distinct attention disorders. Cognitive aspects in ADHD children are measured with an intellectual functioning scale, cognitive and executive function tests. Experimental data show mixed results concerning these subjects. Similar deficits are found between ADHD children, combined and inattentive types, on motor inhibition and different cognitive aspects. However, other executive function aspects need to be explored among the two ADHD sub-groups.