Background and aims. - The association between white matter abnormalities (WMA) and cognitive decline previously reported in poststroke patients has been mainly documented using visual scales. However, automated segmentation of WMA provides a precise determination of the volume of WMA. Nonetheless, it is rarely used in the stroke population and its potential advantage over visual scales is still unsettled. The objective of this study was to examine whether automated segmentation of WMA provides a better account than the visual Fazekas and Wahlund scales of the decline in executive functions and processing speed in stroke patients. Methods. - The analyses were conducted on the 358 patients of the GRECogVASC cohort with an MRI performed at six months poststroke in the Amiens center. WMA were visually analyzed using the Fazekas (subcortical abnormalities) and Wahlund scales. Segmentation was performed using LST (3.0.3). Following preliminary studies to determine the optimal segmentation threshold, we examined the relationship between cognitive status and WMA volume computed at each threshold using receiver operating characteristic (ROC) curves. Finally, we assessed the ability of both Fazekas and Wahlund visual scores and WMA volume to account for cognitive scores by using a bivariate Pearson correlation analysis, comparing correlation coefficients with the Fisher transformation and repeating correlation analysis after adjustment for the lesion volume. Results. - Increasing the threshold led to an underestimation of WMA (P = 0.0001) (significant for a threshold >= 0.2) and an improvement in correct rejection of signal changes in the stroke cavity (P = 0.02) (significant for a threshold <= 0.5), susceptibility artifacts (P = 0.002) (significant for a threshold <= 0.6), and corticospinal degeneration (P = 0.03) (significant for a threshold <= 0.5). WMA volume decreased with increasing threshold (P = 0.0001). Areas under the curve (AUC) did not differ according to the threshold (processing speed: P = 0.85, executive cognitive functions: P = 0.7). Correlation coefficients between cognitive scores and WMA were higher for WMA volume than the Fazekas (processing speed: Z = -3.442, P = 0.001; executive functions: Z = -2.751, P = 0.006) and Wahlund scores (processing speed: Z = -3.615, P = 0.0001; executive functions: Z = -2.769, P = 0.006). Adjustment for lesion volume did not alter the correlations with WMA volume (processing speed: r = -0.327 [95%CI: -0.416; -0.223], P = 0.0001; executive functions: r = -0.262 [95%CI: -0.363; -0.150], P = 0.0001). Conclusion. - This study shows that WMA volume assessed by automated segmentation provides a better account of cognitive disorders than visual analysis. This should favor its wider use to refine imaging determinants of poststroke cognitive disorders. (c) 2024 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Seventy-five percent of people with an acquired brain injury are of working age, most of them are young adults who want to return-to-work or need to resume a vocational training. However, a failure in returning to work/vocational training is associated with depression and isolation. Our aim was to identify objective measures to allow clinicians to anticipate failure in resuming vocational training following a brain injury. Neuropsychological data from 343 patients with brain injury, who benefited from a vocational rehabilitation program (UEROS Lille, France) between 2002 and 2017, were retrospectively analyzed. After completing this program, 28 patients resumed a vocational training and we identified, trough machine learning algorithms, the neuropsychological measures predicting vocational outcome. Success in resuming vocational training after brain injury was predicted by mnemonic scores (verbal forgetting and visual retrieval). The scores obtained on the Tower of London test predicted both success and failure. Our study highlighted that neuropsychological measures underlying planning abilities could help clinicians to anticipate a failure in resuming vocational training in patients with brain injury. Planning and memory abilities would predict an effective vocational outcome. These initial results, that need to be confirmed with larger samples of patients with brain injury who resumed vocational training, may have a relevant implication for neuropsychological practice, allowing a better vocational guidance of these patients.

Au-delà des classiques signes d'examen reflétant les troubles du transfert de l'information à l'hémisphère effecteur de la réponse verbale ou motrice, les lésions du corps calleux peuvent s'associer à des symptômes moteurs d'intensité variable, souvent spectaculaires, prenant l'apparence d'un conflit opposant les deux mains (« dyspraxie diagonistique »). Ces phénomènes sont généralement transitoires après lésion aiguë du corps calleux. De survenue imprévisible, ils touchent la main non-dominante selon une fréquence variable, parfois pluri-quotidienne, et questionnent la capacité du sujet à demeurer l'agent de ses propres actions. Simple réponse réflexe à un stimulus situé dans l'espace de préhension ou véritable conflit intentionnel, les processus cognitifs et les systèmes neuraux engagés dans l'émergence de ces phénomènes restent mal définis. Le présent exposé a pour objectif de décrire le phénomène clinique et d'en discuter quelques hypothèses explicatives.

Visual field disorders, frequently observed in brain-damaged patients, are associated with an adverse prognosis in outcome activities as car driving. In France, a prefectorial order contraindicates driving if the visual field is inferior to 120° on the meridian axis, inferior to 20° on a vertical axis and with defects in a 20° radius from the center. Our aim was to study patients' abilities to distribute their visual attention in space, in case of visual field disorders. Thirty-eight patients with a hemianopia and 49 with a visual defect in the central 20 degrees performed a Useful Field Of View procedure (UFOV). This computer-based assessment contains three attentional tasks: a processing speed task to detect a target in central vision, a divided attention task involving to detect simultaneously a central and a peripheral target, a selective attention task consisting in detection of a central and a peripheral target in attendance of visual distractors. Brain-damaged patient performance was compared to cut-off scores elaborated in a previous study with healthy neurological volunteers (Marks et al., 2015). Only one patient with hemianopia reached normal performance in UFOV tasks. All others patients with hemianopia could not distribute their visual attention in the amputee visual field. However, ten patients among the 49 with a visual defect in the central 20 degrees reached normal performance in UFOV tasks, proving their normal abilities to distribute visual attention in space despite the visual field disorder. When the visual field disorder concerns the central 20 degrees, some patients could balance out it using their visual attentional abilities and maybe in these cases, a driving simulator try and/or an "on-road" try could be proposed before to examine the driving restriction.

The neglect syndrome is frequently associated with neglect dyslexia (ND). ND is characterized by omissions or misread initial letters of words. In clinical settings, ND is usually assessed with "paper and pencil" tests. However, without controlling exposure time of items and patients' response time, ND could be unnoticed. Our computerized procedure consists of four tasks: a single word reading task, a lexical and a semantic decision task and a text reading task. In each task, the time exposure of the items is controlled and we measured both the errors and the participants' response time. Twenty-eight brain-damaged patients, including 12 neglect patients, and 30 healthy neurological participants carried out this procedure. As expected, neglect patients produced more errors and are slower than brain-damaged patients and healthy volunteers and this especially during the single word reading task. This task shows 256 items: pseudo-words mixed with words (frequent or not, long or short) displaying in different ways (horizontal, vertical without anisometry or with a left or a right anisometry) with or without a spatial index. All this materiel permits error patterns to emerge according to the clinical state (neglect patients, brain-damaged patients or neurological healthy volunteers). Our study aimed at proposing computerized tasks to help the diagnostic of neglect dyslexia. The neglect dyslexia could be observed with or without a severe neglect syndrome. In the case of a light neglect syndrome, having a computerized assessment is important in the ND diagnostic process especially as specific pattern have been observed based on the analyses of the error and the response time in the single word reading task.

Purpose. - The useful field of view is a test which takes into account the influence of patient attention during the evaluation of the visual field. This study aims to generate normative data for an adaptation of the useful field of view (UFOV) test. These normative data are essential to judge, in a clinical setting, whether patients' performance is normal or not across demographically similar peers, in order to advise whether or not to resume driving after a brain injury (traumatic brain injury, stroke or cerebral tumour).Patients and methods. - This study examined demographic influences on an UFOV adaptation in a sample of 52 control participants (17 males and 35 females, aged 19 to 69) with no prior ophthalmologic or neurologic history. This adaptation used three visual attention tasks. In a simple task (ST), the participant had to detect, as fast as (s)he could, a single target in a visual display; in a double task (DT,) (s)he had to detect both a central and a lateral target in a double task with visual distractions present on the screen. The number of missed targets and the time needed to detect them are measured.Results. - Time to detect target was found to differ by gender and by age. Men and young people (from 19 to 29 years) are faster at detecting central and lateral targets. However, no demographic influence was observed on the number of missed targets.Conclusions. - A normative table for this French UFOV adaptation is provided. This will allow clinicians to compare patient performance with similar peers and may help in identifying persons who would benefit from training on a driving simulator or having a road test with a drivingschool. (C) 2015 Elsevier Masson SAS. All rights reserved.

Les pathologies neuro-dégénératives peuvent induire, parfois précocement, des troubles cognitifs susceptibles de se répercuter sur l’activité professionnelle [1]. Étant donné le caractère souvent invisible de ces déficits lors d’un entretien classique, l’évaluation neuropsychologique, par l’utilisation de tests normés et aux passations standardisées, va objectiver et préciser les déficits cognitifs au sein des différentes sphères cognitives (mémoire, attention, fonctions exécutives). Ce bilan va appréhender la personne également par rapport à son comportement, sa cognition sociale et la connaissance de ses difficultés (anosognosie et/ou déni). L’expérience de terrain (UEROS de Lille), où les personnes victimes de lésions cérébrales acquises bénéficient d’un bilan cognitif et d’évaluations en situations professionnelles réelles (stages en entreprise), permet d’identifier l’impact des déficits cognitifs en situation de travail [2]. Ainsi, différents types d’aménagements visant au maintien dans l’emploi peuvent être suggérés. Concernant les troubles mnésiques, un déficit de mémoire de travail peut induire une difficulté de rétention des consignes et une inefficacité lors de la réalisation simultanée de plusieurs tâches. Ainsi, la présentation des consignes à l’écrit et la décomposition du travail en plusieurs tâches faites les unes après les autres, sont adaptées. Un déficit de mémoire épisodique touchant le mécanisme d’encodage peut induire une incapacité ou une lenteur d’adaptation aux changements, à l’évolution de l’entreprise et limiter l’intégration de données nouvelles. Privilégier les tâches déjà connues, aménager un temps de travail supplémentaire pour l’adaptation aux tâches nouvelles, donner les informations à l’écrit peuvent aider. L’atteinte du mécanisme de stockage, limitant les apprentissages et/ou leur consolidation dans le temps (oubli) va générer une difficulté d’adaptation aux nouveautés voire une désorientation dans le travail. Il peut alors être nécessaire de procéder par automatisation (tâches répétitives), d’établir des repères contextuels fixes et d’adapter la nature des informations (visuelles/verbales). L’atteinte du mécanisme de récupération des informations en mémoire génère une perte d’efficacité pour retrouver les informations apprises. La mise en place de stratégies mnémotechniques dès l’encodage, la prise de notes, le soutien éventuel des collègues peuvent pallier ce déficit. Concernant les troubles attentionnels, un ralentissement global va limiter le rendement et peut nécessiter un aménagement du temps de travail et/ou des tâches. Les fluctuations attentionnelles apparaissent davantage compatibles avec un travail au forfait plutôt qu’à la chaîne. La fatigabilité, réduisant le rendement au cours de la journée ou d’une tâche, rend préférable un travail à temps partiel et ou l’aménagement de périodes de repos. Un déficit d’attention sélective, gênant le traitement d’une masse de données, nécessite une adaptation du support de travail visant à neutraliser les informations superflues. Enfin, un défaut d’attention divisée, limitant le traitement de données multiples, peut se compenser par la réduction des stimulations, l’aménagement du travail en tâches uniques successives. Concernant les troubles exécutifs, un défaut d’inhibition des interférences peut nécessiter l’aménagement de l’environnement en limitant les informations « distractives ». Un déficit de flexibilité demande de restreindre les passages d’une tâche à l’autre. Un défaut de planification ou de résolution de problèmes, générant un manque d’autonomie, peut se pallier par l’écriture de plans d’action ou la mise en place d’un tutorat. Les troubles comportementaux sur le versant d’une désinhibition peuvent induire une désadaptation sociale limitant l’intégration de la personne au sein de l’entreprise et parfois les possibilités d’insertion professionnelle. Ces troubles nécessitent un travail d’information auprès de l’environnement humain du travailleur [3] et le maintien de la communication avec celui-ci notamment après tout débordement. Sur le versant d’un apragmatisme, le défaut d’initiative ou de passage à l’action requiert un encadrement et l’établissement de repères contextuels susceptibles d’initier l’acte. Enfin, les déficits de conscience des troubles risquent d’induire une incompréhension ou une difficulté d’adhésion de la personne aux aménagements suggérés et mettre en échec ceux-ci. Les « feed back » réguliers peuvent induire et travailler la prise de conscience. Le suivi psychologique en parallèle est souvent nécessaire. Ainsi les troubles cognitifs constituant un handicap invisible peuvent avoir des impacts majeurs en situation professionnelle. La particularité des atteintes cognitives au sein des pathologies neuro-dégénératives étant le caractère évolutif de ceux-ci. L’efficacité des aides reste tributaire de l’évolution de la pathologie, des réajustements constants apparaissant donc nécessaires.

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.

Small artery infarction, which is particularly prevalent among Asians (1), carries a lower risk of recurrent stroke at one-month compared with other stroke subtypes, but long-term findings are inconsistent (2,3). Data on subsequent myocardial infarction risk after small artery stroke are limited. We compared the incidence of vascular events following ischemic stroke due to small artery disease vs. other etiologies among prospectively recruited Asian patients admitted to the Singapore General Hospital from 2005 to 2007. Telephone follow up at a median of 30 months (IQR 24–34) masked to clinical information was obtained for 89% of the cohort. Among the 731 patients with known stroke etiology, 49% had small artery infarction, 38% had large artery infarction, 12% had cardioembolic, and 1% had other etiology. Figure 1 shows the cumulative incidence of subsequent vascular events. Using Cox regression adjusted for age, gender, hypertension, diabetes, hyperlipidemia, smoking, and atrial fibrillation, small artery infarction was associated with a lower incidence of recurrent stroke [hazard ratio (HR) 0·62; P = 0·047], myocardial infarction (HR 0·45; P = 0·031), vascular death (HR 0·18; P = 0·002), and composite vascular events (HR 0·59, P = 0·007) compared with nonsmall artery stroke. The lower risk of subsequent vascular events following small artery infarction may be explained by a differing underlying pathology from large artery and Correspondence: Deidre Anne De Silva*, Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, 169608 Singapore. E-mail: gnrdsd@sgh.com.sg

Introduction. Memory symptom exaggeration or malingering in the forensic neuropsychological evaluation of well-documented brain pathology is seldom described. For some, documented neuropathology and malingering are considered to be mutually exclusive. Case report. We report an original clinical observation of an amnesic factitious disorder in a patient with progressive multiple sclerosis. This patient, who was seen for a routine comprehensive neuropsychological evaluation, demonstrated a severe memory encoding deficit in a classical standard episodic memory test This amnesic syndrome was not in agreement with the neurological condition where deficits in retrieval memory processes are essentially observed. Moreover, his performance at two symptom validity tests fell below the admitted cut-off scores. In fact, the patient obtained an accuracy score of 3 (cut-score < 10) in the Rey's 15-Items Test, a well known malingered amnesia measure. His performance in the 21-Items Test French adaptation was well below the proposed cut-off score of 15121 and inferior to the results obtained by an Alzheimer patients group (n=30). A clinical approach of memory symptom exaggeration is described. We discuss the diagnosis of this false disorder. Conclusion. This case report demonstrates unequivocally that memory symptom exaggeration or malingering can and does occur in patients seen without litigious contexts and who have a well-documented neurological pathology. Failure to address malingering may compromise neuropsychological clinical findings. Nevertheless, there is a lack of up-to-date standard French-language documentation in this topic.

INTRODUCTION:Memory symptom exaggeration or malingering in the forensic neuropsychological evaluation of well-documented brain pathology is seldom described. For some, documented neuropathology and malingering are considered to be mutually exclusive.CASE REPORT:We report an original clinical observation of an amnesic factitious disorder in a patient with progressive multiple sclerosis. This patient, who was seen for a routine comprehensive neuropsychological evaluation, demonstrated a severe memory encoding deficit in a classical standard episodic memory test. This amnesic syndrome was not in agreement with the neurological condition where deficits in retrieval memory processes are essentially observed. Moreover, his performance at two symptom validity tests fell below the admitted cut-off scores. In fact, the patient obtained an accuracy score of 3 (cut-score<10) in the Rey's 15-Items Test, a well known malingered amnesia measure. His performance in the 21-Items Test French adaptation was well below the proposed cut-off score of 15/21 and inferior to the results obtained by an Alzheimer patients group (n=30). A clinical approach of memory symptom exaggeration is described. We discuss the diagnosis of this false disorder.CONCLUSION:This case report demonstrates unequivocally that memory symptom exaggeration or malingering can and does occur in patients seen without litigious contexts and who have a well-documented neurological pathology. Failure to address malingering may compromise neuropsychological clinical findings. Nevertheless, there is a lack of up-to-date standard French-language documentation in this topic.

This case report confirms that a clinical callosal disconnection could be observed in multiple sclerosis. Moreover, this case describes a new kind of strange manual behavior related to callosal disconnection. This behavior could neither be considered as a diagonistic dyspraxia nor as an alien hand, but they evoke rather a conflict of intentions.