[Risk factors and psychological vulnerabilities to binge-drinking in youth]. / Facteurs psychologiques et de personnalité dans le binge-drinking chez les jeunes.

For years, a large number of studies have demonstrated the harmful effects of alcohol consumption on the brain and therefore on behavior and cognition. These studies first aimed at identifying the consequences of alcohol abuse consumption, more specifically in pathologies such as alcohol-dependence or Korsakoff syndrome. Researchers then also started to focus on vulnerabilities to alcohol consumption, especially in hyper fast alcohol consumption called binge-drinking (BD). Indeed BD, which is a particularly dangerous form of alcohol consumption, is usually observed in adolescents and young adults. Typically, young people tend to adopt this way of drinking in order to reach a massive and expeditious intoxication. The aim of this paper is to present the bibliographic data available on the main risk factors to BD and to describe the main measurement tools for investigating these factors in clinical researches. The interaction between psychological dysfunctions and BD is not well understood. For a better understanding of the links between binge-drinking and psychological and personality factors in terms of vulnerability or risk, studies have investigated on affective factors (depression and anxiety), personality characteristics (impulsivity and sensation seeking) and drinking motives (coping, improvement, compliance and wellness). Although different factors are often associated with BD in adolescents and young adults, it is still not clear whether these factors are the consequences of alcohol consumption or a reflection of pre-morbid abnormalities predisposing individuals to excessive alcohol consumption. Furthermore, results are not unequivocal and various distinct personality profiles seem to emerge. Thus, these questions are still not fully resolved and further studies are needed to understand the complex relationships between BD and the various psychological or personality factors. The need for investigating these factors in clinical studies is nevertheless important with regard to therapeutic interventions. Indeed, the identification of specific profiles involved in a binge-drinking type of consumption could allow an adaptation of the contents of therapeutic programs by targeting a specific mechanism. For example, recent findings have revealed that when factors such as impulsivity are considered, therapeutic intervention is more effective.

Neuropsychological assessment and cerebral vascular disease: the new standards.

Vascular cognitive impairment (VCI) includes vascular dementia (VaD), vascular mild cognitive impairment (VaMCI) and mixed dementia. In clinical practice, VCI concerns patients referred for clinical stroke or cognitive complaint. To improve the characterization of VCI and to refine its diagnostic criteria, an international group has elaborated a new standardized evaluation battery of clinical, cognitive, behavioral and neuroradiological data which now constitutes the reference battery. The adaption of the battery for French-speaking subjects is reported as well as preliminary results of the on-going validation study of the GRECOG-VASC group [Clinical Trial NCT01339195]. The diagnostic accuracy of various screening tests is reviewed and showed an overall sub-optimal sensitivity (<0.8). Thus, the general recommendation is to perform systematically a comprehensive assessment in stroke patients at risk of VCI. Furthermore,the use of a structured interview has been shown to increase the detection of dementia. In addition to the well known NINDS-AIREN criteria of VaD, criteria of VCI have been recently proposed which are based on the demonstration of a cognitive disorder by neuropsychological testing and either history of clinical stroke or presence of vascular lesion by neuroimaging suggestive of a link between cognitive impairment and vascular disease. A memory deficit is no longer required for the diagnosis of VaD as it is based on the cognitive decline concerning two or more domains that affect activities of daily living. Both VaMCI and VaD are classified as probable or possible. These new criteria have yet to be validated. Considerable uncertainties remain regarding the determinant of VCI, and especially the lesion amount inducing VCI and VaD. The interaction between lesion amount and its location is currently re-examined using recent techniques for the analysis of MRI data. The high frequency of associated Alzheimer pathology is now assessable in vivo using amyloid imaging. The first studies showed that about a third of patients with VaD due to small vessel disease or with poststroke dementia have amyloid PET imaging suggestive of AD. These new techniques will examine the interaction between vascular lesions and promotion of amyloid deposition. Although results of these on-going studies will be available in few years, these data indicate that efforts should be done in clinical practice to reduce underdiagnosis of VCI; VCI should be examined using a specific protocol which will be fully normalized soon for French-speaking patients; the sub-optimal sensitivity of screening tests prompts to use a structured interview to grade Rankin scale and to perform systematically a comprehensive assessment in stroke patients at risk of VCI; poststroke dementia occurring after 3 months poststroke may be preventable by treatment of modifiable vascular risk factors and secondary prevention of stroke recurrence according to recent recommendations.

Differences in effective connectivity between dyslexic children and normal readers during a pseudoword reading task: an fMRI study.

PURPOSE: This fMRI study investigated phonological and lexicosemantic processing in dyslexic and in chronological age- and reading level-matched children in a pseudoword reading task. MATERIALS AND METHODS: The effective connectivity network was compared between the three groups using a structural model including the supramarginal cortex (BA 40; BA: Brodmann area), fusiform cortex (BA 37) and inferior frontal cortex (BA 44/45) areas of the left hemisphere. RESULTS: The results revealed differences in connectivity patterns. In dyslexic patients, in contrast with chronological age- and reading level-matched groups, no causal relationship was demonstrated between BA 40 and BA 44/45. However, a significant causal relationship was demonstrated between BA 37 and BA 44/45 both in dyslexic children and in the reading level-matched group. CONCLUSIONS: These findings were interpreted as evidence for a phonological deficit in developmental dyslexia.

[Clinical interest of fMRI and functional exploration methods of brain activity and interactivity: physical and neurophysiological considerations]. / Intérêt clinique de l'IRMf et des méthodes d'exploration fonctionnelle de l'activité et de l'interactivité cérébrales : considérations physiques et neurophysiologiques.

After having provided a brief reminder of the principle of the blood oxygen level-dependent (BOLD) contrast effect, the physiological bases of brain activity and the concepts of functional integration and effective connectivity, we describe the most recent approaches, which permit to explore brain activity and putative networks of interconnected active areas in order to examine the normal brain physiology and its dysfunctions. We present various methods and studies of brain activity analysis clinically applicable, and we detail the concepts of functional and effective connectivity, which allow to study the cerebral plasticity which occurs at the child's during the maturation (e.g., dyslexia), at the adult during the ageing (e.g., Alzheimer disease), or still in schizophrenia or Parkinson disease. The study of specific circuits in networks has to allow defining in a more realistic way the dynamic of the central nervous system, which underlies various cerebral functions, both in physiological and pathological conditions. This connectivity approach should improve the diagnostic and facilitate the development of new therapeutic strategies.