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.

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.

Using simple successive tasks we assessed the influence of Alzheimer's disease on the processing of different odours. Fifteen patients with Alzheimer's disease, 15 old control subjects and 15 young control subjects were tested. The experiment included two sessions. Initially 12 odorants were presented, one odorant every minute. For each odour the subjects were asked to rate intensity, pleasantness, familiarity and edibility using linear rating scales. The odorants were then presented a second time and the subjects were asked to identify them. The results show that the intensity scores were lower in old control subjects and Alzheimer patients than in the young control subjects and that familiarity and identification scores were lower in Alzheimer patients than in old control and young control subjects. When we compared the five olfactory tasks the impairment of performance in Alzheimer patients was relatively higher for identification than familiarity, itself higher than the intensity judgement. No difference was observed between the three groups of subjects for pleasantness and edibility judgements.

The contribution of striatal (caudate nucleus–putamen) dopaminergic deficiency to the severity of motor signs is well established in Parkinson's disease (PD), while its role in the occurrence of cognitive and mood changes remains unresolved. We therefore measured in 27 non-demented PD patients and 10 age-matched controls striatal uptake of [18F]-6-fluoro-l-Dopa (F-Dopa) with PET, and mood (Beck depression), memory (Grober–Buschke), frontal executive functions (verbal fluency and Wisconsin card sorting), and attentional processing of sensory stimuli (N2–P3 auditory event-related potentials — ERPs). Locomotor disability of patients was assessed by Hoehn and Yahr score and Unified Parkinson's Disease Rating Scale (UPDRS). ANOVA showed that memory, but neither frontal lobe functions nor ERPs, was significantly altered in PD patients, whereas indices of depression were found only in advanced PD. The F-Dopa rate constant Ki was significantly reduced in the striatum, more in putamen than caudate nucleus, and inversely correlated with disease duration. A significant inverse correlation was found between both putamen and caudate nucleus Ki and Hoehn and Yahr score, and between putamen — but not caudate nucleus Ki — and UPDRS motor score. Principal components analysis (PCA) of PD patients Ki values and mood, cognitive and ERP parameters gave a three-factor solution. Variables contributing to factor 1 were memory score and N2–P3 ERP latencies, those to factor 2 were striatal Ki values, and those to factor 3 frontal executive performances. Depression did not segregate with any variable. Our findings suggest that unlike locomotor disability, cognitive abilities and mood state of non-demented PD patients are for the most part unrelated to striatal dopaminergic depletion and may result from dysfunction of extra-striatal dopaminergic or from non-dopaminergic systems.

We report the case of a 72-year-old right-handed man, M. B., who, after a right posterior parietal infarction, developed a spatial or afferent agraphia. Language function and limb praxis were normal. The patient had no left-sided neglect but a mild visuo-constructional disorder. Spelling knowledge was preserved in oral spelling and block letter writing. Writing errors were resent only in cursive handwriting, and were part of those usually observe in afferent agraphia: spatially malformed letters, repetitions or omissions of strokes, failure to dot i's or to cross t's. Furthermore, he significantly increased his error rate when his capacity to use visual or kinaesthetic feedback to control his writing movements was impaired, confirming that the shape and the number of strokes and letters are partially controlled by visual and kinaesthetic feedback. However, M. B. had no wide left margin, no wandering lines, and no unnecessary gaps between words or letters. Thus, he showed a dissociation characterized by the presence of stroke and letter errors in the absence of symptoms of left-sided neglect agraphia. Combined with patients V.B. and S.P., M.B. confirmed (1) that symptoms of spatial agraphia can be fractionated into two dissociable clusters, one related to left-sided neglect and the other related to letter and stroke errors because of feedback impairments; and (2) that different functional deficits underlie the different types of writing error noted in afferent or spatial agraphia.

The rehabilitation of memory must be defined in terms of patient selection, therapist support and techniques as accurately as for language therapy. Three objectives can be offered for organic amnesia: reorganizing the memory by using alternative intact routes; working with remaining intact memory as the implicit focus, modification of surroundings with 'mnemonics protheses' such as a diary, alarms. The approach must be cognitive for the theoretical support of therapists, but also pragmatic to respect the patient's needs and wishes in the context of family and job. Patient selection must be based not only on rigorous aetiological and neurological grounds but also on an individual and cognitive understanding of each patient.

The aim of our approach was to improve the memory of head injured memory impaired people without associated intellectual deterioration. Subjects participated in group each weekday during ten weeks. The aim of strategies was to help the patient of recovery learning strategies. Exercises can be repeated to produce the use of learning strategies in the real life. 19 patients (11 subjects with a traumatic brain injury and 8 subjects with a cerebral vascular accident) completed the treatment are measured before and after the rehabilitation. In a clinic study our memory therapy was more satisfactory on visual memory than verbal memory on a French standardised memory test (the Signoret memory battery). But there is no change in the evaluation of everyday memory measured with the AMQ of Van Der Linden. The comparison of the two sub groups has given to show which pathology will benefit the more the method. These first findings suggested that it was useful to reinforce everyday memory and to include the family members more. It will also be interesting to modify the program for the reeducation of the verbal memory. A control study was necessary to evaluate the validity of our approach.

The aim of our approach was to improve the memory of head injured memory impaired people without associated intellectual deterioration. Subjects participed in group each weekday during ten weeks. The aim of stategies was to help the patient of recovery learning stategies. Exercises can be repeated to produce the use of learning strategies in the real life. 19 patients (11 subjects with a traumatic brain injury and 8 subjects with a cerebral vascular accident) completed the treatment are measured before and after the rehabilitation. In a clinic study our memory therapy was more satisfactory on visual memory than verbal memory on a French standardised memory test (the Signoret memory battery). But there is no change in the evaluation of everyday memory measured with the AMQ of Van Der Linden. The comparaison of the two sub groups has given to show which pathology will benefit the more the method. These first findings suggested that if was useful to reinforce everyday memory and to include the family members more. It will also be interesting to modify the program for the reeducation of the verbal memory. A control study was necessary to evaluate the validity of our approach.

A 57 year-old woman developed a slowly progressive environmental agnosia and dressing apraxia without disturbances of language, memory, orientation and social activities. Two years later, alexia, agraphia, visual agnosia, constructional apraxia, simultagnosia and imitation apraxia of nonsymbolic gestures were also noted. Ophthalmic examination demonstrated a left inferior quadranopsia. Oral comprehension was normal. There was no loss of insight, and behavioral response was appropriately concerned. Computed tomography and magnetic resonance imaging revealed bilateral cortical atrophy in parieto-occipital areas, most pronounced on the right side, with enlargement of the ventricles. Positron emission tomography demonstrated low flow and metabolism values in the right parietal, temporal and occipital regions. This case is very similar to those of posterior cortical atrophy recently reported by Benson et al. (1988). It suggests a selectively degenerative dysfunction of posterior association cortex, sparing oral language and verbal memory.

A 57 year-old woman developed a slowly progressive environmental agnosia and dressing apraxia without disturbances of language, memory, orientation and social activities. Two years later, alexia, agraphia, visual agnosia, constructional apraxia, simultagnosia and imitation apraxia of nonsymbolic gestures were also noted. Ophthalmic examination demonstrated a left inferior quadranopsia. Oral comprehension was normal. There was no loss of insight, and behavioral response was appropriately concerned. Computed tomography and magnetic resonance imaging revealed bilateral cortical atrophy in parieto-occipital areas, most pronounced on the right side, with enlargement of the ventricles. Positron emission tomography demonstrated low flow and metabolism values in the right parietal, temporal and occipital regions. This case is very similar to those of posterior cortical atrophy recently reported by Benson et al. (1988). It suggests a selectively degenerative dysfunction of posterior association cortex, sparing oral language and verbal memory.