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Objective Adult attention-deficit/hyperactivity disorder (ADHD) is characterized by a dysexecutive syndrome reflected in cognitive, emotional, and behavioral areas. Independently of a formal diagnosis of ADHD, higher ADHD symptoms are associated with higher levels of insomnia and sleepiness symptoms in adult population-based samples. Insomnia and sleepiness are sleep disorders that are both associated with deficits in several aspects of executive functions which in turn are likely to mimic a range of ADHD symptoms. Our objective was to explore the interrelationships between ADHD, insomnia, and sleepiness symptoms and executive functioning in community-dwelling adults. Method A total of 442 participants (18–89 years, 56% females) underwent a semistructured clinical interview and completed questionnaires for insomnia, sleepiness, and everyday behaviors in which executive functions are implicated. Mediation Models were applied. Results Insomnia and sleepiness symptoms did not play a mediating role between ADHD symptoms and executive functioning. Conversely, our results highlighted a mediating effect of daytime insomnia consequences and sleepiness on ADHD symptoms via behavioral regulation executive symptoms (respectively, β = −0.32, p Conclusions Daytime insomnia consequences and sleepiness symptoms could lead to ADHD-like symptoms through their associated executive symptoms expressed in daily life. When faced with symptoms suggestive of ADHD in adults, insomnia and sleepiness should be systematically screened with standardized instruments.

Introduction Pain of nursing homes residents with Alzheimer’s disease remains under detected compared to their cognitively intact counterparts. Communication difficulties may partly explain this poor quality of care but the influence of stigmatization on pain assessment has never been explored. Research question The objective of this research was to analyze whether a diagnosis label of Alzheimer’s disease or the stage of the disease may bias pain assessment scores and empathic reactions of health care staff in nursing homes. Methods Two studies were conducted based on a similar experimental between-subjects design with a video showing an older adult woman experiencing undefined pain. Different labels and vignettes were manipulated to characterize the subject of the video. In the first study, 84 certified nursing assistants were asked to watch the video and then to assess the pain intensity and their empathic reaction. Participants were randomized in two conditions that varied the disease label (Alzheimer’s disease vs no diagnosis). In the second study, 67 certified nursing assistants were enrolled who did not participate in the first study. They watched the same video as in the first study and assessed the pain intensity and their empathic reaction. They were randomized in two conditions that varied the stage of the Alzheimer’s disease (mild stage vs severe stage). Results Alzheimer’s disease label had no influence on assessment scores. In contrast, the stage of the disease had a significant effect on the health care staff assessments with severe stage associated with lower pain intensity scores and empathic reactions. Conclusion These results confirm that the Alzheimer’s disease stigma is a real phenomenon that tends to be mainly elicited by the symptoms of the acute phase of the disease. These findings are crucial to better understand the stigma related to Alzheimer’s disease and to enhance the pain management of this frail population.

International audience; Purpose: People with dementia are at great risk of their pain being undetected. In long-term care facilities, certified nursing assistants are on the front-line to detect whether a resident with dementia is experiencing pain, but research on certified nursing assistants' abilities to accurately assess pain are scarce. This study aims to examine certified nursing assistants’ pain assessment skills using a simulated standardized video context.Design: A cross-sectional study was conducted.Methods: Fifty certified nursing assistants and 40 individuals with no professional experience in the field of care (controls) watched the same video of an older adult woman with dementia experiencing pain. Afterwards, they completed visual analog scales (pain intensity, affective distress), an observational pain assessment scale (Algoplus), and a set of questionnaires.Results: In both groups, pain intensity assessment and empathic reaction scores showed important interrater variability. Moreover, certified nursing assistants and controls did not differ in detecting the presence of pain or assessing its intensity. But certified nursing assistants displayed lower empathic reactions and dispositions. Certified nursing assistants pain assessment scores decreased with experience and expertise.Conclusions: The practice of pain assessment is challenging for certified nursing assistants in long-term care facilities. Their professional status does not prevent inter-personal inconsistency and tends to lower their empathic dispositions. Personal determinants may interfere with their assessment behaviors and must be considered to enhance pain management for residents with dementia.

Background: Insomnia is a highly common sleep disorder in patients with Parkinson’s disease (PD). Yet, no screening questionnaires following the Diagnostic and Statistical Manual-5 (DSM-5) criteria have been validated in PD patients. Objectives: We assessed the validity and reliability of the French version of the sleep condition indicator (SCI), in patients with PD. Methods: In a sample of 65 patients (46% women, mean age 63.8 ± 7.9 years) with PD, but without dementia, insomnia was assessed with a clinical interview and the SCI. Statistical analyses were performed to determine the reliability, construct validity, and divergent validity of the SCI. In addition, an explanatory factor analysis was performed to assess the underlying structure of the SCI. Results: Of the 65 patients (mean duration PD 9.7 ± 6.9 years), 51% met the criteria for insomnia disorder when measured with a clinical interview. The mean SCI score was 18.05 ± 8.3. The internal consistency (α = 0.89) of the SCI was high. Using the previously defined cutoff value of ≤16, the area under the receiver operating characteristic curve was 0.86 with a sensitivity of 86% and a specificity of 87%. Exploratory factor analysis showed a 2-factor structure with a focus on sleep and daytime effects. Additionally, good construct and divergent validity were demonstrated. Conclusion: The SCI can be used as a valid and reliable screener for DSM-5 insomnia disorder in PD patients. Due to its short length, it is useful in both clinical practice and scientific research.

International audience; Recent evidence suggests that people with schizophrenia are at high risk for severe COVID-19 and should be prioritized for vaccination. However, impaired decision-making capacities could negatively affect the uptake of COVID-19 vaccination in this population. Capacity to consent to COVID-19 vaccination was assessed in 80 outpatients with schizophrenia. Using the MacArthur Competence Assessment Tool for Treatment, 56.3% of the sample were classified as having diminished capacity to consent to the vaccination. Diminished capacity to consent to COVID-19 vaccination was associated with lower vaccination rates, poorer cognition and higher level of psychotic symptoms. Developing interventions for enhancing informed consent for vaccination is urgent within this population.

Insomnia disorder is four times more frequent in Parkinson's disease (PD) than in the general population. In PD, insomnia is associated with a very significant decrease in quality of life and deleterious consequences on both patients and caregivers' health. The main therapeutic option in response to insomnia comorbid to PD is the prescription of benzodiazepines or related drugs. As in the general population, these sedative-hypnotic molecules have very low efficacy in PD and are associated with adverse effects. They are highly addictive and are also associated with drowsiness, risk of falling and decreased life expectancy. These side effects may in themselves be symptoms associated with PD in the absence of insomnia. In this clinical context, we can easily conceive that sedative-hypnotics are likely to potentiate these clinical symptoms in PD. We have recently documented that insomnia disorder comorbid to PD is associated with the classical psychological factors perpetuating insomnia in neurological disease-free individuals with insomnia. These results have allowed us to emphasize that target-oriented interventions for instance cognitive-behavioral therapy for chronic insomnia (CBT-i) should be considered as a treatment approach for insomnia disorder comorbid to PD. As a reminder, for decades, CBT-i is considered the most effective first-line treatment for the management of chronic insomnia associated or not with comorbidity. In this context, we demonstrated the acceptability of CBT-i in the treatment of insomnia comorbid to PD and its effectiveness for the management of night and daytime symptoms of insomnia associated with this neurological condition. The objective of this synthesis is to raise awareness among health professionals of the relevance of psychological therapies (mostly CBT) for insomnia in PD. Unlike drug treatments, these therapies are safety for patients who are already weakened by the PD itself.

Insomnia is a common complaint in Parkinson's disease (PD) affecting more than three-quarters of patients. Longitudinal studies show that insomnia complaint is a persistent condition in PD, especially in patients with more severe insomnia at baseline. When international and standardized criteria are used, it is estimated that more than half of the patients meet the criteria for insomnia disorder. These data define insomnia as the most prevalent sleep disorder in PD. Given that background, it is surprising that none of the scales recommended by the International Parkinson and movement disorder society to assess sleep disturbances in PD is specifically dedicated to the assessment of insomnia disorder. In this insufficient methodological context, we have recently established the discriminant validity of the Sleep condition indicator for insomnia disorder in PD, as diagnosed with a clinical interview according to the DSM-5 criteria. As in the general population, female sex, symptoms of depression, anxiety, fatigue and daytime sleepiness have been associated with insomnia complaint severity in PD. Insomnia also reduces the quality of life of patients affected by PD and that of their caregivers. In contrast, clinical features of the disease were very slightly related to insomnia with small effect sizes. These features include motor fluctuations, autonomic problems, cardiovascular and thermoregulatory dysfunctions and doses of dopaminergic medications. This observation implies not systematically considering insomnia as a symptomatic manifestation secondary to PD but as a clinical entity requiring specific treatment. The objective of this synthesis is to raise awareness among health professionals of the importance of early detection of insomnia in PD in order to limit the consequences associated with its chronicity. Identifying and assessing insomnia in PD is therefore a major health issue.

Objective: To test the efficacy of cognitive behavioral therapy for insomnia (CBT‐i) in Parkinsonʼs Disease (PD) and to evaluate its impact on indices of daytime and psychological functioning. Method: Fifteen patients with insomnia disorder (ID) comorbid to PD were enrolled in a single‐case design with multiple baselines. Total wake time, sleep efficiency, and daytime sleepiness were recorded on a sleep diary. Selfreported measures of insomnia, anxiety and depressive symptoms, health‐related quality of life, and psychological variables perpetuating ID were completed. All patients also underwent a clinical interview for ID diagnosis. Results: CBT‐i was associated with significant changes in sleep variables and ID criteria. Significant positive treatment‐ related effects were also noted for all indices of daytime and psychological functioning, and for variables perpetuating ID. All of these improvements were well maintained at 3‐month follow‐up. Conclusion: CBT‐i is a promising therapeutic avenue for patients with PD.

Introduction Pediatric-onset Evans syndrome (pES) is defined by the association between immune thrombocytopenic purpura (ITP) and autoimmune hemolytic anemia (AIHA) before the age of 18 years and may be associated to various immunopathological manifestations (IMs). No comprehensive study of this rare disease exists, and its long-term outcomes are poorly described. Methods Patients from the nationwide French prospective OBS'CEREVANCE cohort with pES and more than 5 years of follow-up were included (excepted pES secondary to bone marrow transplantation or primary immunodeficiencies known at the inclusion). All patients, including those with less than 5 years of follow-up, were included in survival analyses. Multivariate Cox proportional hazards model was used to analyze factors associated with time-dependent variables. Results Of the 216 patients with pES in the cohort, 151 (88 males and 63 females) were included with a median (min-max) follow-up time after first cytopenia diagnosis of 11.3 (5.1-38) years. Median age at final follow-up was 18.5 (6.8-50.0) years. The proportion of patients achieving a sustained complete response (i.e. persisting until final follow-up) increased after cytopenia onset (Fig. 1A). ITP and AIHA were in complete remission in 40.5% and 54.5%, 74.1% and 62.3%, and 78.4% and 86% of patients at 5, 10, and 15 years, respectively. Clinical IMs (cIMs) developed in 100/151 patients (66%), before the first diagnosis of cytopenia in 21/100 cases. The number of cIMs increased over time (Fig. 1B). The proportions of patients with one and more than one cIM were 50% and 14%, 57% and 19%, and 81% and 44% at 5, 10, and 15 years after the first cytopenia diagnosis, respectively. A broad spectrum of cIMs were present, lymphoproliferation (n = 71), dermatological (n = 26), gastrointestinal/hepatic (n = 23), and pneumological manifestations (n = 16) being the most common. Three patients had a hematological malignancy. Biological IMs (bIMs) were diagnosed in 101/151 patients (67%) and also increased over time, with hypogammaglobulinemia (n = 54) being the most common. Autoimmune neutropenia developed in 43 patients (28.5%) and was independently associated with the number of cIMs (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.5-3.8; p = 0.0002). Severe or recurrent infections were present in 53 patients (35%). The number of second-line treatments received (i.e. other than steroids and immunoglobulins) increased over time without reaching a plateau (Fig. 1C). Half of the patients had received at least one, two, and three different treatments at 2.7, 10.5, and 14.7 years after the first cytopenia diagnosis, respectively. The number of cIMs was independently associated with the number of second-line treatments received (HR, 1.3; 95% CI, 1.08-1.6; p = 0.006). Systemic lupus erythematosus (SLE) was diagnosed in 11/151 patients (7.3%, 1/88 males and 10/63 females) and autoimmune lymphoproliferative syndrome (ALPS) in six (4.0%). Sixteen of the 151 patients followed for more than 5 years (10.6%) died, and seven died before the fifth year of follow-up (23 deaths in total). Survival at 5, 10, and 15 years after the first cytopenia was 97%, 92%, and 84%, respectively (Fig. 1D). Deaths occurred regularly throughout the follow-up period, at a median age of 18.0 (1.7-31.5) years. The most frequent cause of death was infections (n = 12, 52%). Four patients (18%) died of hemorrhage, all were less than 13 years old. The numbers of second-line treatments (HR, 1.3; 95% CI, 1.1-1.6; p = 0.004) and severe or recurrent infections (HR, 3.4; 95% CI, 1.2-9.7; p = 0.02) were independently associated with mortality after 5 years of follow-up. Overall, 20-year-old compared to 10-year-old patients more frequently showed a sustained complete response for AIHA (72% vs. 30%) and ITP (50% vs. 26%), but more frequently had cIMs (74% vs. 37%), bIMs (75% vs. 39%), and ongoing second-line treatments (88% vs. 47%; p < 0.001 for all comparisons). Conclusions Long-term outcomes of pES were associated to IMs and second-line treatment burden, not active cytopenia. The significant mortality rates, mostly among adolescents and young adults, were linked to drug-induced and/or constitutive immunodeficiencies. Few cases were associated with SLE or ALPS, which is consistent with a heterogeneous genetic background. These results highlight the importance of multidisciplinary care during the transition from childhood to adulthood. Figure 1 Disclosures No relevant conflicts of interest to declare.

Objectives: The Montessori Assessment System (MAS) is an assessment tool that aims at assessing preserved abilities in persons with moderate to severe dementia and to serve as basis for person-centered interventions. As responsive behaviors are highly frequent in this population, we assessed their possible influence on the MAS administration and results.Methods: 193 persons with a diagnosis of dementia in the moderate to severe stages living in nursing homes completed the MAS. Responsive behaviors were assessed by the Neuropsychiatric Inventory (NPI).Results: The NPI scores were heterogeneous, but responsive behaviors were present for at least 5 NPI domains in more than 50% of the participants. While NPI scores had weak relationships with MAS completion time and total score, primarily for the hallucinations, euphoria, and aberrant motor behaviors domains, a large majority of the participants fully completed the MAS.Conclusions: The presence of responsive behaviors as assessed by the NPI does not limit MAS administration, despite minor influence on MAS score and completion time.Clinical implications: The MAS may be applied to persons with moderate to severe dementia presenting responsive behaviors. Assessment of preserved abilities can greatly improve the design of person-centered care plans in this population.

Background Fatigue is a well-known common clinical feature of numerous chronic diseases including various forms of cancer, neurological disorders such as multiple sclerosis, and psychiatric disorders. A significant proportion of people with schizophrenia (30–60%) reportedly experience fatigue, which impacts negatively on participation in various activities, including work, study, leisure, and social pursuits. Causes of fatigue in schizophrenia are poorly understood and there are no established treatments. Several evidence-based interventions for fatigue syndrome including psychoeducation, cognitive behavioral therapy, and graded exercise therapy have been shown to be effective in other medical conditions and could be adapted to address fatigue in schizophrenia patients. As there are no psychosocial or pharmacological interventions with proved efficacy for fatigue in schizophrenia, there is an urgent need for the development of strategies to improve fatigue management in schizophrenia. The aim of this project is to evaluate in a single blind randomized clinical trial the efficacy of a cognitive-behavioral therapy (CBT) intervention compared to treatment as usual (TAU) on fatigue as the main outcome in schizophrenia patients. Clinical symptoms, physical functioning, major cognitive functions, quality of life and functioning, treatment dosage, daily motor activity, biological markers with inflammatory markers are also considered as secondary outcomes. Methods/design Two hundred patients meeting the inclusion criteria will be randomized to either of the study arms (intervention or TAU). The ENERGY intervention will be delivered according to a standardized treatment manual comprising six modules addressing fatigue and sleep over 14 individual therapy sessions. The treatment encompasses core CBT principles of psycho-education, behavioral activation, behavioral experiments, cognitive restructuring, problem-solving, and relapse prevention. Sessions will follow the traditional CBT structure of agenda setting, review of homework tasks, and introduction of a new concept/technique with collaborative discussions on how to implement such strategies in the participant’s day-to-day environment. Our primary endpoint will be the severity of fatigue assessed at baseline and at the 9-month follow-up using the “Multidimensional Fatigue Inventory” (MFI). Discussion The trial will provide the first test of CBT intervention for fatigue for patients with schizophrenia. This study will also test to what extent the treatment can be implemented in everyday practice. Trial registration ClinicalTrials.govNCT04332601. Registered on 10 April 2020.

International audience; Attention Deficit/Hyperactivity Disorder (ADHD) often persists into adulthood. However, few screening tools have been adaptedto assess adult ADHD using the DSM-5 criteria. This study assessed the diagnostic accuracy of a French version of the ADHDSelf-Report Screening for DSM-5 (ASRS-5). This multicentric cross-sectional study included 557 participants: 309 adult ADHDoutpatients without bipolar disorder (BD)/borderline personality disorder (BPD) (n = 236) or with BD/BPD (n = 36) and 285adults without ADHD who were either healthy volunteers (n = 248) or outpatients with BD or BPD (n = 37). Measures includedADHD diagnosis and the ASRS-5. The ASRS-5 was a good predictor of ADHD diagnosis (cut-off score ! 13/24: sensitivity =84.3%, specificity = 91.9%) in the sample of adult outpatients without comorbid disorders/healthy controls. Performances werelower with this cut-off score in some subgroups, notably low-severity ADHD symptomatology (sensitivity = 63.5%) and participantswith BD or BPD (sensitivity = 91.7%, specificity = 54.1%). The French ASRS-5 had acceptable screening properties,even if its performance varied according to clinical variables. Further evidence is needed for patients with comorbid disordershaving overlapping symptoms.

International audience; Objective The present study examined the longitudinal association between personality traits and sleep quality in four samples of middle-aged and older adults. Method Participants (N > 22,000) were adults aged 30 to 107 years old from the Wisconsin Longitudinal Study (WLS), the Midlife in the United States Study (MIDUS), the Health and Retirement Study (HRS), and the Midlife in Japan Study (MIDJA). Personality and sleep quality were assessed at baseline and again 4 to 10 years later. Results Scoring lower on neuroticism and higher on extraversion was associated with better sleep quality at baseline and over time, with effect sizes larger than those of demographic factors. Low conscientiousness was associated with a worsening of sleep quality over time. Openness and agreeableness were unrelated to sleep quality. Poor sleep quality at baseline was associated with steeper declines in extraversion, agreeableness, and conscientiousness and a smaller decrease in neuroticism over time. Conclusion Replicable findings across samples support longitudinal associations between personality and sleep quality. This study identified specific personality traits that are associated with poor and worsening sleep quality, and substantiated previous findings that poor sleep quality is associated with detrimental personality trajectories.

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.

In French care facilities for dependent aged people (NHDAP), prevalence of pain among residents with dementia is high, and source of behavior disturbances and quality of life impairment. However, in spite of many international expert statements, pain remains under-assessed and under-managed in these patients. Certified nursing assistants (CNA) are on the front-line in NHDAP to detect the presence of pain in residents with communication difficulties, while they received little training for pain management and directives for specific care. Moreover, no studies were presently devoted to the impact of demographic and socio-professional determinants of CNA on pain assessment. In our study, we assessed the presence and intensity of pain in cognitively impaired residents in NHDAP, by CNA performing as a pair for the morning care. 42 pairs were recruited and independently completed a standardized behavioral assessment for pain (Doloplus scale) as well as a numeric rating scale. CNA personal characteristics were investigated to analyse the determinants of potential assessment discrepancies between each of the pairs. Presence of pain was detected in 51.1 to 91.1% of the patients depending on the tool and analysis criteria. In 28.9% important discrepancies were observed in the pain assessment between the CNA pairs, which could be related to professional status and prior use of the observational assessment. These inter-rater discrepancies should be reduced providing clear pain assessment guidelines for CNA in NHDAP, and further studies should be completed to figure out the role of CNA personal determinants in the patients' pain assessment.

STUDY OBJECTIVES: Insomnia disorder (ID) is highly associated with Parkinson disease (PD) with great negative effect on health-related quality of life. Nonetheless, the relevance of psychological processes involved in the maintenance of insomnia is yet to be established in the context of this neurological condition. Our aim was to examine a serial meditation model of sleep-related safety behaviors and dysfunctional beliefs about sleep in association with presleep cognitive arousal and ID in patients with PD. METHODS: A total of 68 patients with PD completed self-report measures including the Sleep-Related Behaviors Questionnaire (SRBQ-20), Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16), and the cognitive subscale of the Presleep Arousal Scale (PSAS-C). ID was assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Bootstrapped serial mediation analyses were conducted to test indirect effects. RESULTS: Overall, 55.6% of patients with PD met diagnostic criteria for ID. The association between presleep cognitive arousal (PSAS-C) and ID was serially mediated by sleep-related safety behaviors (SRBQ-20) and strong endorsement of dysfunctional beliefs about sleep (DBAS-16) (bias-corrected 95% confidence interval for the indirect effect = 0.013, 0.093). An alternate serial mediation model in which dysfunctional beliefs about sleep precede sleep-related safety behaviors was not statistically significant (bias-corrected 95% confidence interval for the indirect effect = −0.001, 0.046). CONCLUSIONS: ID comorbid to PD is associated with the classic psychological factors perpetuating ID in neurological disease-free individuals with insomnia. Target-oriented interventions for instance cognitive behavioral therapy for chronic insomnia should be considered as a treatment approach for ID comorbid to PD. CITATION: Lebrun C, Gély-Nargeot M-C, Maudarbocus KH, Rossignol A, Geny C, Bayard S. Presleep cognitive arousal and insomnia comorbid to parkinson disease: evidence for a serial mediation model of sleep-related safety behaviors and dysfunctional beliefs about sleep. J Clin Sleep Med. 2019;15(9):1217–1224.

This study investigated the relationship between bedtime counterfactual thoughts, depressive symptoms, nocturnal counterproductive thought-control strategies and insomnia disorder. Six hundred and fifty adults from the general population were recruited and provided data on their counterfactual thoughts' frequency at bedtime, depressive symptoms and use of nocturnal maladaptive strategies of thought control. In addition, all participants followed a face-to-face clinical interview for the diagnosis of insomnia disorder. A model positing moderated mediation was tested using conditional process modelling. Overall, 19% of participants met diagnostic criteria for a chronic insomnia diagnosis. Bootstrapped mediation analyses indicated that the association of bedtime counterfactual processing and insomnia diagnosis is mediated by depressive symptoms (B = 0.035, SE = 0.007, bootstrapped 95% CI = 0.023, 0.051). Furthermore, the effects of such a mediation model were significantly larger among individuals with high levels of aggressive suppression than those with low levels of aggressive suppression (B = 0.002, SE = 0.001, bootstrapped 95% CI = 0.001, 0.004). A second model in which a worry strategy moderates the relationship between bedtime counterfactual processing and depressive symptoms was not statistically significant (B = 0.0036, SE = 0.013, p = .78). The present study adds to the literature on the importance of self-attacking thoughts and negative affects at bedtime. We recommend the evaluation of the impact of adding self-attacks management strategies to cognitive behavior therapy for individuals with an insomnia disorder

International audience; Parkinson’s disease (PD) is the second most common neurodegenerative diseaseafter Alzheimer’s disease. For years, PD has been traditionally defined through motor sympto-matology, but it is now recognized that the non-motor symptoms affecting neuropsychiatric,sleep, autonomic, and sensory domains occur in up to 88% of PD patients, probably resulting ina significant source of disability. In a community-based cross-sectional study, nearly two-thirdsof patients with PD presented nighttime sleeping problems and chronic insomnia was repor-ted among one-third of patients (Gjerstad et al., 2007). This rate is three times higher thanin the general population. According to the American Academy of Sleep Medicine, cognitive-behavioral therapy for insomnia (CBT-i) is the optimal recommendation for the treatment of chronic insomnia, independent of comorbities associated or non-associated with insomnia. Infact, numerous studies have documented the efficiency of CBT-i in the treatment of chronicinsomnia comorbid with a wide spectrum of psychiatric, neurological, oncological and algologi-cal problems (Geiger-Brown et al., 2015). Furthermore, it is important to emphasize that CBTis applicable and efficient in the treatment of several problems frequently associated with PD,such as anxiety, depression and impulsive-compulsive disorders. To our knowledge, there is nospecific data relating to the use of CBT in chronic insomnia comorbid with PD. In this context,the general objective of this study was to look at the efficiency of CBT-i in the treatment ofchronic insomnia comorbid with PD, in an experimental, single-case study. This efficiency wasassessed both by short interval measures (i.e. consensus sleep diary) and by longer intervalmeasures (i.e. self-assessment questionnaires). The latter concerned complaints of insomniaas well as dysfunctional thoughts and attitudes about sleep. The patient was a 62-year-old manwho was diagnosed with PD at the age of 59. Two years after diagnosis, insomnia developed. Thepatient’s predominant daily complaint concerned dissatisfaction with both sleep quantity andquality, associated with difficulty falling sleep, and difficulty staying asleep with inability to fallback to sleep. Insomnia was associated with excessive daytime sleepiness and depressive symp-toms. CBT-i treatment was carried out over six sessions in accordance with the interventionalprotocol suggested by Morin (Morin & Espie, 2003). Psychoeducation treated sleep functioningand insomnia; sleep restriction consisted in limiting the number of hours spent in bed to thenumber of real hours of sleep; stimulus control involved instructions aimed at reinforcing theassociation between sleep and temporal and contextual indices; cognitive restructuration wascentred around dysfunctional beliefs related to sleep; education on sleep hygiene included theteaching of good sleeping habits. Finally, three post-therapeutic evaluations (at two weeks,one month and three months) were carried out by an independent assessor and included thecompletion of a sleep calendar as well as different clinical evaluation scales. The results of thevisual analysis confirmed by Wilcoxon signed-rank tests, as well as the temporal series analysis show a signification reduction in the total awakening time (−72%, Z = −3.23, P = 0.001), aswell as a significant increase in sleep efficiency (+16%, Z = −3.17, P = 0.002) between the base-line and post-therapy stage. These improvements in sleep were maintained at one and threemonth follow-ups. The average efficiency of sleep increased significantly between the base-line and one-month follow-up (+19%, Z = −3.29, P = 0.001) as well as between the baseline andthree-month follow-up (+21%, Z = −3.29, P = 0.001). At the three-month follow-up the patientno longer met the diagnostic criteria of chronic insomnia (DSM-V). Improvement in sleep wasaccompanied by improvement in mood, in daytime drowsiness, in insomnia indices such as theinsomnia severity index, in dysfunctional beliefs and attitudes about sleep and in the state ofcognitive and somatic activation prior to going to bed. This single-case study demonstrates thefeasibility and potential benefit of CBT for insomnia comorbid with PD while providing importantinformation necessary to design more definitive studies in the future.; L’insomnie est une plainte très fréquente dans la maladie de Parkinson (MP). Elle est rapportée par environ 70 % des patients et son caractère est chronique dans 30 % des cas. À ce jour, l’efficacité des traitements pharmacologiques de l’insomnie associée à la MP est très modeste, et les répercussions à long terme (par exemple, tolérance, dépendance ou risque de chute) de certaines molécules n’ont jamais été vérifiées dans ce contexte. Selon l’Academy of Sleep Medicine, la thérapie comportementale et cognitive de l’insomnie (TCC-i) est une recommandation de premier niveau pour la prise en charge de l’insomnie chronique,et ce, indépendamment de comorbidités associées à l’insomnie. Plusieurs études soutiennent que les TCC sont applicables et efficaces dans la prise en charge de plusieurs problématiques associées à la MP. Il s’agit de la dépression, de l’anxiété, et plus récemment, des troubles impulsifs-compulsifs. Nous rapportons ci-dessous le cas d’un patient atteint de MP,souffrant d’une insomnie chronique, caractérisée par des pensées et attitudes dysfonctionnelles concernant le sommeil, des comportements incompatibles avec le sommeil et un contexte émotionnel négatif. Nous avons mis en place une TCC selon un protocole classiquement décrit dans le traitement de l’insomnie chronique. Les résultats obtenus montrent, d’une part, la faisabilité et l’efficacité de la TCC-i dans la prise en charge de l’insomnie chronique en cormobidité de la MP. Et, d’autre part, que l’amélioration du sommeil est elle-même associée à une amélioration de l’humeur, de la somnolence diurne et des croyances et attitudes dysfonctionnelles vis-à-vis du sommeil. Les TCC semblent constituer une voie thérapeutique prometteuse dans la prise en charge de l’insomnie chronique en comorbidité de la MP. Leur validité devra être confirmée par des études complémentaires.

International audience; Sleepiness and mind-wandering are frequently experienced by patients with attention-deficit/hyperactivity disorder (ADHD), without ever having been jointly explored. We aimed to investigate the co-occurrence of these two phenomena in ADHD adults. Drug-free ADHD adults (n = 25) and healthy controls (n = 28) underwent an online experience sampling of mind-wandering episodes and subjective sleepiness. Participants completed self-reported measures of mind-wandering and sleepiness in daily life. Higher trait of mind-wandering was observed in ADHD patients compared to controls. On the whole sample, self-reported mind-wandering propensity was strongly associated with the severity of inattentive, impulsive and hyperactive symptoms. During the probes, patients reported more frequent episodes of mind-wandering and mind-blanking, and higher sleepiness. Their mind-wandering episodes were less intentional and belonged less frequently to a structured succession of thoughts. In both groups, mind-wandering and mind-blanking were associated with higher sleepiness. On the SART, patients were less accurate than controls. We provide first initial evidence for higher propensity of mind-wandering and mind-blanking using experience sampling in patients with formal ADHD diagnosis. This propensity was associated with sleepiness without negatively impacting attention performances. Mind-wandering and sleepiness have common determinants potentially involved in ADHD pathophysiology. Correlates of mind-blanking in ADHD adults remain to be characterized.

Background: Patients with schizophrenia (SZP) have been reported to exhibit impairments in reward-based decision-making, but results are heterogeneous with multiple potential confounds such as age, intelligence level, clinical symptoms or medication, making it difficult to evaluate the robustness of these impairments.\ud \ud \ud Methods: We conducted a meta-analysis of studies comparing the performance of SZP and healthy controls (HC) in the Iowa Gambling Task (IGT) as well as comprehensive analyses based on subject-level data (n = 303 SZP, n = 188 HC) to investigate reward-based decision-making in SZP. To quantify differences in the influence of individual deck features (immediate gain, gain frequency, net loss) between SZP and HC, we additionally employed a least-squares model.\ud \ud Results: SZP showed statistically significant suboptimal decisions as indicated by disadvantageous deck choices (d from 0.51 to −0.62) and lower net scores (d from −0.35 to −1.03) in a meta-analysis of k = 29 samples (n = 1127 SZP, n = 1149 HC) and these results were confirmed in a complementary subject-level analysis. Moreover, decision-making in SZP was characterized by a relative overweighting of immediate gain and net losses and an underweighting of gain frequency. Moderator analyses revealed that in part, decision-making in the IGT was moderated by intelligence level, medication and general symptom scores.\ud \ud Conclusion: Our results indicate robust impairments in reward-based decision-making in SZP and suggest that decreased cognitive resources, such as working memory, may contribute to these alterations.

Background In spite of their extensive use, the ecological relevance of tasks dedicated to assessing real-world decision-making in a laboratory setting remains unclear. Objectives Our study aimed to evaluate the relationship between decision-making and behavioral competency and awareness of limitations. Methods A total of 20 patients with Alzheimer's disease (AD), 20 with amnestic mild cognitive impairment (aMCI) and 20 healthy controls (HC) were assessed for decision-making using the Iowa Gambling Task (IGT). Behavioral competency was evaluated by the Patient Competency Rating Scale (PCRS), which requires each participant and a relative to answer the same 30 questions on participant's competency and to rate each item, while awareness of limitations was evaluated by subtracting the self-rated score from the relative-rated score. Results Using the median-split approach, the proportion of disadvantageous decision-makers was higher in both the MCI and AD groups than in HC (P = 0.02 and P = 0.03, respectively), with no differences between clinical groups. The percentage of participants with poorer behavioral competency was also higher in the MCI and AD than in the HC (self-rated: P = 0.025 and P = 0.01, respectively; relative-rated: P = 0.008 and P = 0.008, respectively), again with no differences between MCI and AD. All groups were comparable in awareness. For all participants, disadvantageous decision-making was associated with both reduced behavioral competency and poor awareness of limitations (OR: 3.47, P = 0.03 and OR: 5.4, P = 0.004, respectively). Conclusion Our findings support the ecological relevance of the IGT. Behavioral competency integrity and awareness of limitations are both associated with advantageous decision-making profiles.

Introduction Dans la maladie de Parkinson (MP), l’apathie et l’impulsivite sont considerees comme deux expressions motivationnelles d’un spectre comportemental de la dysfonction dopaminergique, i.e. apathie, hypodopaminergie ; impulsivite, hyperdopaminergie. Objectifs Notre objectif est d’etudier les relations entre apathie et impulsivite dans la MP, impulsivite envisagee dans ce travail comme un construit multidimensionnel au travers du modele dominant UPPS. Methodes Soixante patients atteints de MP idiopathique sans demence et leur conjoint(e) ont ete recrutes. Les patients ont complete l’echelle UPPS a 4 facteurs (urgence, manque de premeditation, manque de perseverance et recherche de sensations) et la version courte de la Lille Apathy Rating Scale (LARS-S). La version hetero-evaluee de l’UPPS a ete administree aux 60 conjoint(e)s. Le diagnostic d’apathie a ete etabli selon le score seuil de −7 de la LARS. Resultats A la LARS, 39 % (n = 24) des patients avaient un diagnostic d’apathie. Les patients avec diagnostic d’apathie presentaient des niveaux plus faibles de perseverance que les patients non apathiques tant pour les modalites auto et hetero-evaluees de l’echelle UPPS (respectivement, p = 0,022 et p = 0,020). Aucune difference significative n’a ete retrouvee entre les deux groupes pour les dimensions urgence, absence de premeditation et recherche de sensations (tous les p > 0,30). Discussion Notre etude est la premiere a mettre en lien l’apathie et l’impulsivite en inscrivant l’impulsivite dans une perspective multidimensionnelle. La presence d’un symptome dit « hypodopaminergique » (l’apathie) n’exclut pas la presence d’un symptome dit « hyperdopaminergique » (l’impulsivite). Il serait interessant d’etudier des variables mediatrices du lien entre ces deux concepts comme par exemple les fonctions executives. Conclusion Dans la MP, l’impulsivite envisagee dans une perspective multidimensionnelle presente un recouvrement conceptuel avec l’apathie. La dimension absence de perseverance apparait significativement contribuer a la symptomatologie apathique.

International audience; Study Objectives: Despite the high comorbidity of insomnia disorder (ID) with multiple sclerosis (MS), the relevance of psychological processes involved in the maintenance of insomnia is yet to be established in this neurological disorder. This study aimed to ascertain to what extent the suggested emotional, cognitive, and behavioral processes maintaining insomnia are relevant in people with insomnia and MS. Methods: A between-subjects design was used to compare 26 patients with insomnia and MS, with 31 patients with MS only, and with 26 matched neurological disease-free individuals with insomnia. All patients participated in a standardized clinical interview and completed a battery of self-reported measures of cognitive and somatic presleep arousal experienced at bedtime, sleep- or insomnia-related unhelpful beliefs, and sleep-related safety behaviors. All patients with MS underwent a neurological examination. Results: ID comorbid to MS was strongly associated with increased levels of cognitive and somatic arousal, higher endorsement of dysfunctional beliefs about the consequences of insomnia on daytime functioning, and worry about insomnia and more frequent engagement in sleep-related safety behaviors. Patients with MS with ID did not differ from neurological disease-free individuals with insomnia on these measures. No link was found between MS clinical peculiarities and ID diagnosis. Conclusions: ID comorbid to MS is associated with the classical psychological factors perpetuating ID in neurological disease-free individuals with insomnia. Primary care providers and neurologists should consider target-oriented therapies like cognitive behavioral therapy for chronic insomnia as a treatment approach for ID comorbid to MS.

This study evaluated the validity and reliability of the Montessori Assessment System. The Montessori Assessment System assesses preserved abilities in persons with moderate to severe dementia. In this respect, this instrument provides crucial information for the development of effective person-centered care plans. A total of 196 persons with a diagnosis of dementia in the moderate to severe stages of dementia were recruited in 10 long-term care facilities in France. All participants completed the Montessori Assessment System, the Clinical Dementia Rating Scale and/or the Mini Mental State Examination and the Severe Impairment Battery-short form. The internal consistency and temporal stability of the Montessori Assessment System were high. Additionally, good construct and divergent validity were demonstrated. Factor analysis showed a one-factor structure. The Montessori Assessment System demonstrated satisfactory psychometric properties while being a useful instrument to assess capabilities in persons with advanced stages of dementia and hence to develop person-centered plans of care.

Summary Insomnia disorder is frequent in the population, yet there is no French screening instrument available that is based on the updated DSM-5 criteria. We evaluated the validity and reliability of the French version of an insomnia screening instrument based on DSM-5 criteria, the Sleep Condition Indicator, in a population-based sample of adults. A total of 366 community-dwelling participants completed a face-to-face clinical interview to determine insomnia disorder against DSM-5 criteria and several questionnaires including the French Sleep Condition Indicator version. Three-hundred and twenty-nine participants completed the Sleep Condition Indicator again after 1 month. Statistical analyses were performed to determine the reliability, construct validity, divergent validity and temporal stability of the French translation of the Sleep Condition Indicator. In addition, an explanatory factor analysis was performed to assess the underlying structure. The internal consistency (α = 0.87) and temporal stability (r = 0.86, P

Chronological age is commonly used to explain change in sleep. The present study examines whether subjective age is associated with change in sleep difficulties across middle adulthood and old age.Participants were drawn from the second (2004-2005) and third (2013-2014) waves of the Midlife in the United States Survey (MIDUS, N = 2350; Mean Age: 55.54 years), the 2008 and 2014 waves of the Health and Retirement Study (HRS, N = 4066; Mean Age: 67.59 years) and the first (2011) and fourth (2014) waves of the National Health and Aging Trends Survey (NHATS, N = 3541; Mean Age: 76.46). In each sample, subjective age, sleep difficulties, depressive symptoms, anxiety and chronic conditions were assessed at baseline. Sleep difficulties was assessed again at follow-up.Sleep difficulties.An older subjective age at baseline was related to an increase in sleep difficulties over time in the three samples, and was mediated, in part, through more depressive symptoms, anxiety and chronic conditions. Feeling older was associated with an increased likelihood of major sleeping difficulties at follow-up in the three samples.Subjective age is a salient marker of individuals' at risk for poor sleep quality, beyond chronological age.

IF 3.326; International audience; Kabuki syndrome (KS-OMIM 147920) is a rare developmental disease characterized by the association of multiple congenital anomalies and intellectual disability. This study aimed to investigate intellectual performance in children with KS and link the performance to several clinical features and molecular data. We recruited 31 children with KMT2D mutations who were 6 to 16 years old. They all completed the Weschler Intelligence Scale for Children, fourth edition. We calculated all indexes: the Full Scale Intellectual Quotient (FSIQ), Verbal Comprehension Index (VCI), Perceptive Reasoning Index (PRI), Processing Speed Index (PSI), and Working Memory Index (WMI). In addition, molecular data and several clinical symptoms were studied. FSIQ and VCI scores were 10 points lower for patients with a truncating mutation than other types of mutations. In addition, scores for FSIQ, VCI and PRI were lower for children with visual impairment than normal vision. We also identified a discrepancy in indexes characterized by high WMI and VCI and low PRI and PSI. We emphasize the importance of early identification and intensive care of visual disorders in patients with KS and recommend individual assessment of intellectual profile.

Introduction L’insomnie chronique (IC) est le trouble du sommeil le plus prevalent dans la sclerose en plaques (SEP) avec des consequences deleteres sur la qualite de vie des patients. Objectifs Evaluer les facteurs comportementaux, cognitifs et emotionnels generalement associes au maintien de l’IC en l’absence de comorbidite neurologique dans le contexte specifique de l’IC comorbide de la SEP. Patients et methodes Cinquante sept patients avec SEP dont 26 patients avec IC (SEP_IC + ) et 31 sans IC (SEP_IC-) ainsi que 26 participants avec IC sans comorbidite neurologique (IC + ) ont ete recrutes. Tous les participants ( n = 83) ont complete un entretien semi-structure pour l’evaluation et le depistage de troubles du sommeil et un entretien psychologique. Les comportements contre-productifs et croyances dysfonctionnelles a l’egard du sommeil ainsi que l’etat d’activation emotionnelle et cognitive nocturnes ont ete evalues par auto-questionnaires. Resultats Comparativement au groupe SEP_IC-, le groupe SEP_IC+ avait plus de croyances dysfonctionnelles, adoptaient plus frequemment des comportements contre-productifs a l’egard du sommeil et presentaient une activation emotionnelle et cognitive plus intenses. Ces differences etaient independantes de la severite des symptomes de la SEP et de la presence de troubles de l’humeur et de l’anxiete. Aucune difference n’a ete observee entre les groupes SEP_IC+ et IC+ pour les variables comportementales, cognitive et d’activation. Discussion De facon originale, nous avons montre que l’IC dans la SEP est associee a un ensemble de facteurs cognitifs, emotionnels et comportementaux similaires a ceux observes dans l’IC sans comorbidite neurologique. Nos resultats soulignent l’importance d’envisager l’IC comorbide de la SEP comme un trouble a part entiere, plutot sous-tendu par des facteurs psychologiques que par la severite de la maladie. Conclusion La prise en charge par therapie cognitivo-comportementale devrait constituer une voie therapeutique prometteuse dans la prise en charge de l’IC en comorbidite de la SEP.

International audience; 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.

Introduction Rhythmic auditory cueing improves certain gait symptoms of Parkinson's disease (PD). Cues are typically stimuli or beats with a fixed inter-beat interval. We show that isochronous cueing has an unwanted side-effect in that it exacerbates one of the motor symptoms characteristic of advanced PD. Whereas the parameters of the stride cycle of healthy walkers and early patients possess a persistent correlation in time, or long-range correlation (LRC), isochronous cueing renders stride-to-stride variability random. Random stride cycle variability is also associated with reduced gait stability and lack of flexibility. Method To investigate how to prevent patients from acquiring a random stride cycle pattern, we tested rhythmic cueing which mimics the properties of variability found in healthy gait (biological variability). PD patients (n = 19) and age-matched healthy participants (n = 19) walked with three rhythmic cueing stimuli: isochronous, with random variability, and with biological variability (LRC). Synchronization was not instructed. Results The persistent correlation in gait was preserved only with stimuli with biological variability, equally for patients and controls (p's

Recent advances in the identification of susceptibility genes and environmental exposures provide strong support that narcolepsy-cataplexy is an immune-mediated disease. Only few serum cytokine studies with controversial results were performed in narcolepsy and none in the cerebrospinal fluid. We measured a panel of 12 cytokines by a proteomic approach in the serum of 35 patients with narcolepsy-cataplexy compared to 156 healthy controls, and in the cerebrospinal fluid of 34 patients with narcolepsy-cataplexy compared to 17 non-narcoleptic patients; and analyzed the effect of age, duration and severity of disease on the cytokine levels. After multiple adjustments we reported lower serum IL-2, IL-8, TNF-α, MCP-1 and EGF levels, and a tendency for higher IL-4 level in narcolepsy compared to controls. Significant differences were only found for IL-4 in cerebrospinal fluid, being higher in narcolepsy. Positive correlations were found in serum between IL-4, daytime sleepiness, and cataplexy frequency. The expression of some pro-inflammatory cytokines (MCP-1, VEGF, EGF, IL2, IL-1β, IFN-γ) in either serum or CSF was negatively correlated with disease severity and duration. No correlation was found for any specific cytokine in 18 of the patients with narcolepsy with peripheral and central samples collected the same day. Significant decreased pro/anti-inflammatory cytokine profiles were found at peripheral and central levels in narcolepsy, together with a T helper 2/Th1 serum cytokine secretion imbalance. To conclude, we showed some evidence for alterations in the cytokine profile in patients with narcolepsy-cataplexy compared to controls at peripheral and central levels, with the potential role of IL-4 and significant Th1/2 imbalance in the pathophysiology of narcolepsy.

Study Objectives: To assess whether the frequency of impulse control disorders (ICDs), addictive behaviors, impulsivity, and impairment of decision-making task performance under ambiguous and risky conditions were present in patients with restless legs syndrome (RLS) and whether changes could be related to dopaminergic medications. Design: Case-control prospective study. Setting: Academic Sleep Disorders Center. Participants: Of the 149 participants, there were 39 who were drug free with primary RLS, 50 who were taking dopamine agonists (DA), and 60 control subjects. Participants were assessed with a clinical interview screening for ICDs, augmentation syndrome, impulsivity, depression, and addictive behaviors. All participants completed two decision-making tasks, one under an ambiguous condition (Iowa Gambling Task) and the other under a risky condition (Game of Dice Task). Drug-free patients with RLS underwent 1 night of polysomnography recording. Measurements and Results: Seventy percent of patients were treated with pramipexole (median dose, 0.36 mg), and 30% with ropinirole (median dose, 0.75 mg). Median duration of DA intake was 11 mo (range, 1-72 mo). No differences were found on impulsivity scores, ICDs, and substance addiction between drug-free patients or those taking DA, or control subjects. Patients with RLS reported more depressive symptoms than control subjects, but without differences between patients taking or not taking DA. Drug-free and treated patients demonstrated reduced performances on the Iowa Gambling Task but not on the Game of Dice Task compared to control subjects, with no differences between patients taking medications and those who were not. No association was found between decision-making task performances, or polysomnographic and clinical variables. Conclusion: Impulse control disorders, impulsivity, and substance addiction were infrequent in drug-free patients with restless legs syndrome or those treated with a low dose of dopamine agonists. However, patients with restless legs syndrome, either drug free or taking dopamine agonists, had preferences toward risky choices on the Iowa Gambling Task, which led to negative consequences in the long run, a condition potentially leading to further development of impulse control disorders.

Savoir prendre de bonnes decisions (dans son interet ou celui de ses proches) releve d’une faculte indispensable a notre adaptation, notre autonomie, voire notre survie. Pour autant, cette aptitude n’est pas aisee car la prise de decision est une faculte complexe, composite, qui s’avere particulierement sensible aux effets de l’avancee en âge. Deux modalites de prise de decision sont distinguees : la prise de decision sous ambiguite, lorsque la probabilite du resultat est ignoree et la prise de decision sous risque, lorsque les consequences et leurs probabilites sont connues. Cette revue de la litterature presente les effets du vieillissement normal et pathologique sur ces deux modalites decisionnelles. Dans le vieillissement cerebral/cognitif dit normal, la diminution des aptitudes en prise de decision s’explique principalement par le declin executif lie a l’âge, la modalite prise de decision sous risque paraissant mieux preservee. Au cours du vieillissement cerebral/cognitif dit pathologique, la localisation des lesions anatomiques joue un role pregnant sur le type de troubles decisionnels. Ainsi, les lesions frontales et/ou sous-corticofrontales conduisent a une prise de risque majeure, surtout en condition ambigue. Les lesions frontales affectent le role des renforcements utiles a la prise de decision sous ambiguite, en entravant la connaissance de la probabilite du resultat. Les dysfonctionnements executifs et la degradation du systeme de recompense alterent la prise de decision sous risque, empechant l’anticipation des consequences et la connaissance des probabilites sur le resultat. Les lesions temporales ou temporofrontales affectent les deux conditions decisionnelles. Ici, l’alteration de la prise de decision sous ambiguite parait liee aux difficultes a apprendre par « feed-back » afin d’estimer correctement la probabilite du resultat. La deterioration de la prise de decision sous risque s’explique par l’incapacite a apprecier correctement les probabilites des consequences. Ces donnees soulignent la complexite et la variete des mecanismes et des processus mis en jeu lors des activites de prise de decision. Elles permettent aussi d’expliquer les dissociations observees en fonction de type de lesions cerebrales relevees dans la cadre du vieillissement normal et pathologique.

An increased incidence of narcolepsy in children was detected in Scandinavian countries where pandemic H1N1 influenza ASO3-adjuvanted vaccine was used. A campaign of vaccination against pandemic H1N1 influenza was implemented in France using both ASO3-adjuvanted and non-adjuvanted vaccines. As part of a study considering all-type narcolepsy, we investigated the association between H1N1 vaccination and narcolepsy with cataplexy in children and adults compared with matched controls; and compared the phenotype of narcolepsy with cataplexy according to exposure to the H1N1 vaccination. Patients with narcolepsy-cataplexy were included from 14 expert centres in France. Date of diagnosis constituted the index date. Validation of cases was performed by independent experts using the Brighton collaboration criteria. Up to four controls were individually matched to cases according to age, gender and geographic location. A structured telephone interview was performed to collect information on medical history, past infections and vaccinations. Eighty-five cases with narcolepsy-cataplexy were included; 23 being further excluded regarding eligibility criteria. Of the 62 eligible cases, 59 (64% males, 57.6% children) could be matched with 135 control subjects. H1N1 vaccination was associated with narcolepsy-cataplexy with an odds ratio of 6.5 (2.1-19.9) in subjects aged