Cognitive emotion regulation questionnaire: Psychometric properties of the Tunisian version

OBJECTIVES

This study investigated the psychometric properties of the Cognitive Emotion Regulation Questionnaire in a Tunisian Arabic-Speaking population.

METHOD

The CERQ original version was translated and back-translated and then administrated to 360 participants. Afterwards, using the explanatory and confirmatory factor analysis, we studied the latent factor structure for CERQ. The internal consistency of the subscales was assessed by Cronbach's alfa coefficients, and the test-retest and interscale reliability were assessed with Pearson correlations. The criterion validity was also examined using correlations between the CERQ subscales and both the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) scales at first evaluation and at a one year follow-up.

RESULTS

The Tunisian version was quite satisfactory with the nine-factor structure, as in the original CERQ. Moreover, all validity and reliability measures were comparable to the original CERQ.

CONCLUSION

The present study is the first work devoted to a Tunisian adaptation of the CERQ. Our findings highlight that the Tunisian version is both reliable and valid for the measurement of cognitive emotion regulation strategies.

[Eating behavior in pediatric obesity: Of the advantages of combining the neurobiological and neuropsychological approaches]

Obesity is currently considered a major public health concern, as shown by the growing number of people with excess weight, alarmingly in infants, and despite medical care. Many studies have underlined the reasons for medical care failure caused by an inability to sustain a resistant behavior towards palatable food (high sugar and fat content). Hence, previous research has highlighted connections between excessive eating behavior and the activity of neurotransmitters in brain areas involved in affective behavior and the reward circuit. Reduction of the dopaminergic activity in the prefrontal orbital and limbic cortex may raise the question of executive skills, which play a major role in social adaptation and behavior control. These findings remind us of the need to grasp environmental and behavioral factors to better identify cognitive and affective profiles and improve childhood obesity treatment.

Discrepancy between social and nonsocial decision-making under uncertainty following prefrontal lobe damage: the impact of an interactionist approach

Deficits in decision-making are thought to contribute significantly to socio-behavioral impairments of patients with frontal lobe damage. The purpose of this study was to test the hypothesis of whether the inappropriate social behavior of patients with frontal lesions can be viewed as the product of a general failure of decision-making ability or as the result of socio-cognitive impairment. We studied a group of patients with prefrontal lesions (FL patients, n = 15) and a group of matched healthy controls (n = 30) on the Iowa Gambling task (IGT) of nonsocial decision-making, environmental dependency phenomena (EDP) during social interaction, and the "reading the mind in the eyes" and "character intention task" of theory of mind (TOM) tasks. The FL patients were impaired in both TOM and EDP protocols but, surprisingly, they behaved appropriately in the IGT. In addition, FL patients with EDP did not differ in executive functioning, IGT and TOM measures from those who did not demonstrate these behavioral disorders. The right orbitofrontal cortex was associated with social decision-making deficits. By adopting an interactionist approach, this study raises the possibility of identifying components of social and nonsocial decision-making, which could be helpful in understanding the behavioral disorders of FL patients.

Assessment of everyday executive functioning in children with frontal or temporal epilepsies

Executive functions are particularly vulnerable in case of brain disruption during childhood, when the brain is not fully mature. Some studies showed impairments of executive functions in children with epilepsy, but only a few of them investigated the impact of executive dysfunctions on daily life. The aim of this study was to understand the everyday executive functioning of children with epilepsy both at home and in school. We administered the Behavior Rating Inventory of Executive Function to parents and teachers of 53 children (7-16 years of age) with structural epilepsies or epilepsies of unknown cause of temporal lobe (n=25) or frontal lobe (n=28). The results indicated a global executive impairment in the whole group of patients, compared with normative data, with no difference between the group with temporal lobe epilepsy (TLE) and that with frontal lobe epilepsy (FLE), except for monitor domain, which seemed more frequently impaired in the group with FLE. Congruence between parent and teacher ratings was found. The frequency of seizures was not related to executive dysfunction, whereas the number of antiepileptic drugs tended to positively correlate with working memory impairment. Onset of epilepsy at a younger age was also related to more executive difficulties but only according to teacher ratings. Lastly, duration of epilepsy was strongly associated with executive deficits reported in the context of school. Our results support the executive dysfunction hypothesis in daily life of children with structural focal epilepsy or focal epilepsy of unknown cause and are consistent with the early brain vulnerability hypothesis currently prevalent in the context of child neuropsychology. The BRIEF appears to be a clinically useful tool for assessing executive function impairment in this clinical population.

Deficit of cognitive inhibition in depressed elderly: a neurocognitive marker of suicidal risk

BACKGROUND

Cognitive deficits, in relation to ventral and dorsal prefrontal cortex dysfunctions, have been associated with a higher risk of suicidal acts in young adult patients. Although a public health concern, much less is known about the neurocognitive basis of suicidal behavior in elderly. Here, we aimed at assessing alterations in cognitive inhibition, a suspected major mechanism of the suicidal vulnerability, in suicidal depressed elderly.

METHODS

We compared 20 currently depressed patients, aged 65 and older who recently attempted suicide to 20 elderly subjects with a current depression but no personal history of suicide attempt and 20 elderly controls. Using an extensive neuropsychological battery, we particularly examined different aspects of cognitive inhibition: access to relevant information (using the Reading with distraction task), suppression of no longer relevant information (Trail Making Test, Rule Shift Cards), and restraint of cognitive resources to relevant information (Stroop test, Hayling Sentence Completion test, Go/No-Go).

RESULTS

After adjustment for age, intensity of depression, Mini-Mental State Examination score and speed of information processing, suicidal depressed elderly showed significant impairments in all 3 domains of cognitive inhibition in comparison to both control groups.

LIMITATIONS

Our results need replication in a larger sample size.

CONCLUSIONS

Our study suggests that the inability to inhibit neutral information access to working memory, restrain and delete irrelevant information may impair the patient's capacity to respond adequately to stressful situations subsequently leading to an increased risk of suicidal behavior during late-life depression. Interventions may be developed to specifically target cognitive impairment in the prevention of suicide in depressed elderly.

Cognitive inhibition in suicidal depressed elderly

Rationale

Deficits in executive functions may play a leading role in late-life suicide behaviours.

Objective

To determine whether executive functions, and more specifically cognitive inhibition, could be associated with increased risk of suicidal behaviours among depressed elderly individuals.

Methods

We compared 10 depressed suicide attempters aged 65 and older with 10 depressed suicide non-attempters matched for age, gender and education. To assess cognitive inhibition, we used neutral material, in the form of the Modified Card Sorting Test (MCST), Go-No-Go task (GNG) and Stroop test (ST). The Brixton Spatial Anticipation test (BSA), the dual-task performance and verbal fluencies test were also used to assess flexibility, planning tasks and memory.

Results

Suicidal (mean, 75.30 years; 70% female) and non-suicidal (mean, 72.90 years; 70% female) depressed groups were comparable in terms of burden of physical illness and severity of depression according to the Hamilton Depression Scale (mean score 27.90, p = 0.529). Suicide attempters showed greater impairments in cognitive inhibition as illustrated by significant between-group differences in the number of MCST errors (p = 0.023) and MCST preservative errors (p = 0.035), and by the trend of worse performance on GNG (p = 0.052). No significant differences were found in the scores on ST, BSA, dual-task performance and in semantic or phonemic verbal fluencies. Furthermore, suicide attempt was also associated with GNG score (adjusted Odds Ratio = 0.25 [95CI = 0.07–0.95], p = 0.041) after adjustment for age.

Conclusions

Our case-control study shows that poor cognitive inhibition is associated with suicidal behaviours in late-life depression.

Psychosocial quality of life in patients after total laryngectomy

OBJECTIVES

To examine Psychosocial Quality-of Life (PSQL) changes occurring over time among patients treated for laryngeal carcinoma by total laryngectomy.

METHODS

A retrospective, observational transversal study was performed on PSQL changes over time in laryngeal carcinoma patients having undergone total laryngectomy. Patients were interviewed using a questionnaire developed by two sociologists and a head and neck surgeon. Changes over time were assessed according to information with regards to smoking, alcohol consumption, psychological well-being, social life, family support, occupation and medical and demographic data regarding age, gender, verbal communication and patient appearance.

POPULATION

150 patients completed the questionnaire. All were aged over 50 years at the time of surgery (total laryngectomy). Eighty-five percent of patients were smokers and 81% drinkers. On average, the questionnaires were completed by patients 6 years after surgery.

RESULTS

Before and after total laryngectomy, no statistical differences were noted for marital status (p = 1.000), frequency of dining at home with friends (p = 0.175), frequency of weekend outings (p = 0.092) or frequency of holidays (p = 0.565). A significant decrease was noted for smoking and drinking (p < 0.001), frequency of going to a café (p < 0.001), frequency of dinner outings at friends' homes (p = 0.032) and frequency of going out to a restaurant (p < 0.001). A significant increase was observed in: owning a pet (p = 0.02) and time spent watching television (p < 0.001).

CONCLUSION

The two latter results are indicative of feelings of solitude among total laryngectomees. Tracheostoma and voice deprivation are limiting factors in social relationships, hence pushing individuals into withdrawal.

[Frontal lobe, executive functions and cognitive control]

The approach of executive functions began with the early description of behavioural disorders induced by frontal damage. The development of neuropsychology has led to the description of a large variety of cognitive disorders. The interpretation in cognitive terms of these disorders has emphasized the critical impairment of executive functions which are involved in non-routine situations. The role of working memory, initially suggested by animal studies, has also largely influenced theoretical approaches. Numerous studies have been interpreted within the theoretical frameworks developed by Shallice and by Baddeley. A large amount of studies have allowed the specification of control processes (initiation, inhibition...). Recent studies are beginning to investigate cognitive disorders underlying behavioural changes such as deficits of emotional, social and metacognitive processes. In addition these studies seriously question the assumption of a unique central control system. These studies have deeply influenced the clinical approach, the assessment and the diagnosis of executive syndrome. For clinical practice, these data lead to favour specific assessment of some key behavioural and cognitive deficits based on a battery of tests and structured interview of an informant.

Cognitive changes in asymptomatic carriers of the Huntington disease mutation gene

Huntington disease (HD) is a neurodegenerative disorder due to an excessive number of CAG repeats in the IT15 gene on chromosome 4. Studies of cognitive function in asymptomatic gene carriers have yielded contradictory results. This study compared cognitive performance in 44 subjects with the HD mutation (group of carriers) who had no clinical signs of HD and 39 at-risk individuals without HD mutation (group of non-carriers). Neuropsychological evaluation focused on global cognitive efficiency, psychomotor speed, attentional, executive and memory functions. Significant differences, with lower performances in the group of gene carriers, were detected for some measures of psychomotor speed, attention and executive functioning (all P < 0.01). More differences between groups were observed for memory measures, in particular on the California Verbal Memory Test. Complementing these observations, cognitive scores were correlated with age in the group of gene carriers, but not in the group of non-carriers. This suggests that the cognitive changes precede the appearance of the motor and psychiatric symptoms in HD and that tests proved to be sensitive to early HD deficiencies are better suited than global cognitive efficiency scales to observe them.

Étude de la planification de l’action au moyen du test du plan du zoo dans la maladie d’Alzheimer

INTRODUCTION

Executive dysfunction is regularly reported in patients with Alzheimer's disease. Nevertheless few studies have focused on planning ability in this neurodegenerative disease.

OBJECTIVES

This study aimed to investigate the formulation and the execution of plans in Alzheimer's disease using an ecological planning subtask derived from the Behavioural Assessment of the Dysexecutive Syndrome test battery, the "Zoo Map Test". There are two trials. The first trial consists of a "high demand" version of the subtask in which the subjects must plan in advance the order in which they will visit designated locations in a zoo (formulation level). In the second, or "low demand" version, the subject is simply required to follow a concrete externally imposed strategy to reach the locations to visit (execution level). The test was given to 16 patients with Alzheimer's disease and 13 normal elderly subjects.

RESULTS

The two way ANOVAs mainly showed more difficulties in patients with Alzheimer's disease than in healthy elderly in both conditions. The difference between formulation and execution was greater in patients with Alzheimer's disease than in healthy elderly. Planning impairments mainly correlated with behavioural changes (in particular motivational changes) observed by patient's relatives.

CONCLUSION

These results suggest that patients with Alzheimer's disease have some problems to mentally develop logical strategies and to execute complex predetermined plans, which are partially related to behavioural changes.

What about theory of mind after severe brain injury?

BACKGROUND

Behavioural changes are often reported after a severe traumatic brain injury (TBI). These changes are usually a greater burden for relatives than physical or cognitive impairments. This study investigated social cognition in TBI patients using two theory of mind (TOM) tasks.

METHOD

The performances of 17 patients with severe TBI and 17 matched controls were compared on two tasks designed to investigate understanding of other people's mental states: The 'Reading the Mind in the Eyes' test (RME) and the 'Character Intention Task' (CIT). TBI patients and controls were also given several executive function tasks.

RESULTS

Compared to healthy controls, patients were impaired in most executive tests and in both TOM tasks. No relationship was found between TOM and executive measures. This is consistent with Rowe's position, who suggested an independence between executive functioning and social cognition. These data suggest that TBI patients may have specific social intelligence disturbances.

CONCLUSION

Future work should employ additional tests of TOM and behavioural ratings and recruit more patients in order to complete analysis.

Arrangement de scripts dans la maladie de Huntington

According to Norman and Shallice, the basal ganglia are involved in the activation and maintenance of overlearned or routine scripts in action planning. This study aimed to investigate how patients with Huntington disease manipulate scripts. Ten patients with Huntington's disease and 12 normal control subjects matched by age and education were asked to re-establish the sequential order of series of script actions which were given with or without distractor elements (i.e. with or without actions belonging to trivial scripts). Compared with normal controls, patients with Huntington disease made significantly more errors in script sequencing. However there was no significant difference in performance between patients with Huntington disease and normal control subjects in inhibiting irrelevant actions. These results suggest that early Huntington's disease patients exhibit early impairment in their ability to produce temporally coherent sequences without deficit in their ability to eliminate distractors in the action domain. These results support in part the predictions of Norman and Shallice's model. From a neuroanatomical point of view, this dissociation of performance fits with what is known about the neuropathological progression of Huntington's disease in which neuronal loss progresses in a dorsal-to-ventral direction and with what was shown in patients with circumscribed frontal lobe damage. In these patients, impairment in script sequencing is related to lesions in the lateral prefrontal regions.

Influence of centrality and distinctiveness of actions on script sorting and ordering in patients with frontal lobe lesions

In order to further investigate script knowledge in patients with frontal lobe lesions (FP), 30 participants with frontal brain damage, 14 controls with posterior brain damage (PC) and 30 normal controls (NC) were asked to sort script actions with various degrees of centrality and distinctiveness according to the script to which they belonged and their order of execution. Actions were given in 3 conditions: scripts with headers (SH), scripts without headers (SwH) and scripts with distractor header (SDH). Results confirmed the dual dissociation we observed in a previous study (Allain, Le Gall, Etcharry-Bouyx, Aubin, & Emile, 1999). Twelve FP made numerous errors in sequencing actions regardless of the conditions, but rejected the irrelevant title. Fourteen FP made few sequencing errors but used the irrelevant title. The last 4 FP performed as well as the PC and NC in every condition. Sorting errors made by the FP mainly concerned actions with low levels of centrality and distinctiveness. These data are consistent with the view that frontal lobe lesions selectively impair the syntactic component of script representation without affecting its semantic component.

A case study of selective impairment of the central executive component of working memory after a focal frontal lobe damage

RC is a 36-year-old man who sustained a closed head injury with bilateral frontal lobe hypometabolism in 1978. In 1994, after a lobectomy of a large part of the left frontal lobe, he presented no behavioral disruption and normal performances on most of intelligence, long-term memory, and executive tests. However, he showed deficits in tasks that implicate short-term storage (i.e., span tasks). These deficits in working memory were explored with regard to Baddeley's model using computerized tasks. On these tasks RC showed normal functioning of the articulatory loops and dysfunction of the central executive component in dual tasks. These results confirm those reported in another single case study by Van Der Linden, Coyette, and Seron (1992) and indicate that dual-task performance may assess one separable feature of executive functions.

[Incidence of grasping and its relationship to cerebral lesions]

Grasping is associated with frontal lobe pathology. Nevertheless, there is lack of precise anatomical correlations and very few studies are published. The aim of the study was to determine the incidence of the grasping and its relationship to cerebral lesions. We studied 236 patients admitted to the Neurology Department (108 women and 128 men; mean age 65.3), and tested with a standardized procedure (De Renzi and Barbieri, 1992). A score of grasping was determined for each patient. The locations of the cerebral lesions were assessed by two neurologists using the method of Damasio and Damasio (1989). Grasping was found in 38 patients (16.1p.100) with dementia or cerebral damage. In all cases, the lesion affected the frontal lobe. The patients with grasping showed a significant higher number of lesioned areas particularly for the frontal and the parietal regions. The score of right grasping was significantly higher with a lesion in the right paraventricular frontal and in the left parietal paraventricular areas. The score of left grasping was significantly higher with a lesion in the left frontal paraventricular area. These results are discussed in relationship with motor control.

Mental representation of knowledge following frontal-lobe lesion: dissociations on tasks using scripts

Twenty-three frontal-brain-damaged subjects, 10 posterior-brain-damaged subjects and 10 normal controls were compared on script tasks. They were first asked to re-establish the sequential and hierarchical structure of 2 script actions, and then, they were asked to order 2 new scripts which contained aberrant items. Impairments in script information processing were observed only in frontal patients. Of the 23 frontal patient tested 8 made errors in ordering actions, in choosing scenes and in making estimates of action importance in the first task, and they rejected the aberrant elements in the second task. Eleven frontal subjects performed as well as the control subjects in the first task, but used the irrelevant items. The last 4 frontal patients performed as well as the control subjects in both tasks. These results support a possible fractionation of the frontal lobe syndrome.

Cognitive functions in chronic locked-in syndrome: a report of two cases

We describe a 38-year-old woman and a 38-year-old man who have been living in a "locked-in" condition 3 and 2 years, respectively. Extensive neuropsychological testing, carried out with a communication aid system (writing apparatus) which exploited the patients residual eye movements, showed preserved cognitive abilities in spite of the long standing de-efferentation.

[Traumatic amnesias. Memory disorders consecutive to head injuries]

Traumatic amnesia is a good index predictive of the disablement due sequelae of cranial injuries. The residual memory deficit, correlated with the return to work, mainly affects long-term memory, learning, verbal memory and sensitivity to interferences. The most relevant tests are Rey's 15 words--and particularly their retrieval at 30 minutes--and the verbal fluency test, but the changes in memory observed in the patient's daily life must also be evaluated. Rehabilitation tends to rely on the overall management of intellectual and behavioural disorders, as part of programmes that are specific to subjects with cranial injury.