Spontaneous confabulations and behavioral and cognitive dysexecutive syndrome.

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.

A study of semantic memory after brain injury: Learning newly coined French words.

OBJECTIVE: To investigate semantic memory in brain-injured patients. METHODS: We used the new word questionnaire (QMN) to assess the ability of 12 brain-injured patients and 12 healthy controls to define French words, which had been admitted to the dictionary in 1996 to 1997 or in 2006 to 2007. RESULTS: Despite amnesia or severe executive disorders, the brain-injured patients were able to learn new words and remember those that they already learnt. They successfully selected the relevant phrase in which the new word was placed and were reasonably good at recognizing the right definition from among decoys. In contrast, they had trouble defining the words and compensated for this by giving examples. These problems were correlated with their vocabulary and executive function scores in a battery of neuropsychological tests. CONCLUSION: Our results suggest that frontal injury leads to an impairment in accurate word selection and the scheduling abilities required to generate word definitions.

[Ecologic evaluation in the cognitive assessment of brain injury patients: generation and execution of script]. / Apport de l'évaluation de la cognition dans une tâche de vie quotidienne chez des patients cérébrolésés: génération et exécution d'un script de cuisine.

OBJECTIVE: Assessment of executive functions in an everyday life activity, evaluating brain injury subjects with script generation and execution tasks. MATERIALS AND METHODS: We compared a script generation task to a script execution task, whereby subjects had to make a cooked dish. Two grids were used for the quotation, qualitative and quantitative, as well as the calculation of an anosognosis score. We checked whether the execution task was more sensitive to a dysexecutive disorder than the script generation task and compared the scores obtained in this evaluation with those from classical frontal tests. Twelve subjects with brain injury 6 years+/-4.79 ago and 12 healthy control subjects were tested. The subjects carried out a script generation task whereby they had to explain the necessary stages to make a chocolate cake. They also had to do a script execution task corresponding to the cake making. RESULTS: The 2 quotation grids were operational and complementary. The quantitative grid is more sensitive to a dysexecutive disorder. The brain injury subjects made more errors in the execution task. CONCLUSION: It is important to evaluate the executive functions of subjects with brain injury in everyday life tasks, not just in psychometric or script-generation tests. Indeed the ecological realization of a very simple task can reveal executive function difficulties such as the planning or the sequencing of actions, which are under-evaluated in laboratory tests.

[Self-evaluation of physical, cognitive and mood symptoms in a cohort of traumatic and vascular brain injury patients participating in social and neuropsychological remediation programmes]. / Auto-évaluation de la gêne physique, cognitive et thymique de sujets cérébrolésés. Effet d'une prise en charge spécifique.

INTRODUCTION: We studied 23 vascular or traumatic head injury subjects, five years after their injury. METHODS: Neuropsychological testing included language tests, memory performance, frontal lobe tests and standard tests of intelligence (QI). Behavior was evaluated with the neuropsychiatric interview (NPI). Using an analogic visual scale, subjects performed a self-evaluation of their memory, language, attention, physical and thymic complaints. RESULTS: Neuropsychological assessment was heterogeneous but seemed to show severe impairment. Mean NPI score was 31.4: 91 percent of patients showed depression or anxiety and 78 percent of them showed irritability. Mean memory and thymic complaints were scored 6 on the analogic visual scale. Thymic complaint was not correlated with neuropsychological tests but with physical complaints. Thymic complaint was correlated with NPI score. Language complaint was correlated with VIQ, attentional complaint was correlated with PIQ, memory complaint with memory tests. In a second part, we studied 21 patients again 6 months later and 14 patients 1 year later. Mean complaints were scored over 5 after 6 months and over 4 after 1 year. With neuropsychological remediation and social activities, memory complaints improved significantly after 6 months and attentional and thymic complaints after 1 year. CONCLUSION: Using of analogical visual scales appears to be feasible: patients were able to evaluate their difficulties. This could be useful to elaborate remediation programs and evaluate outcome.