[Decision making and executive function in severe traumatic brain injured patients: validation of a decision-making task and correlated features]. / Prise de décision et fonctions exécutives chez le patient atteint de traumatisme crânien grave: validation d'une tâche de prise de décision et facteurs corrélatifs.

OBJECTIVE: 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. PATIENTS AND METHODS: 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). RESULTS: 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. CONCLUSION: 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.

Self-reported memory complaints and memory performance in elderly French community residents: results of the PAQUID Research Program.

An epidemiological survey of self-reported memory complaints and memory performance [assessed with Benton's visual-retention test (BVRT) and the Wechsler paired-associates test (WPAT)] was undertaken in a community sample of 2,726 noninstitutionalized subjects aged 65 and over living in Gironde (southwestern France). A significant relationship was observed between the presence of self-reported memory problems and lower performance on the BVRT and the WPAT. However, beyond this relationship, there was significant discordance between the two evaluations, explained in part by the fact that the correlates of memory functioning were not related with similar strength to self reports and to actual performance. In general, females and subjects who scored above the depressive symptomatology threshold reported more problems, while lower performances were related to older age and low educational level. The discordance between self reports and actual performance may suggest anosognosia of mild memory deficits and could possibly be a predictor of future intellectual deterioration.

[Aphasic-type language disorders associated with lesions of the putamen and caudate nucleus: clinicopathological findings in one case (author's transl)]. / Troubles du langage de type aphasique et lésions putamino-caudées. Observation anatomo-clinique.

Language disorders developed in a patient following a subcortical infarct involving the left putamen and caudate nucleus. Language was abundant and fluent, with many perseverations, semantic and ideation incoherences, and all activities concerned with verbal or non-verbal expression were affected. Lesions were present in the head and body of the caudate nucleus, the whole of the putamen, the anterior nucleus of the thalamus and the superior part of the internal capsule. The disorder was unique in relation to disturbances of the aphasic type observed in extensive thalamic lesions, or in transcortical sensorial aphasia. Physiopathological interpretation is based on the functional role of the putamen-caudate system in the regulation of many types of behaviour: animal experiments and results of applying stimuli in humans suggests a release of the inhibition exerted by the caudate nucleus on the frontal cortex. Lack of comparable clinicopathological data implies that other similar cases must be reported before the specificity of the disorder can be confirmed.