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Background: Alcoholism affects various cognitive processes, including components of memory. Metamemory, though of particular interest for patient treatment, has not yet been extensively investigated. Methods: A feeling-of-knowing (FOK) measure of metamemory was administered to 28 alcoholic patients and 28 healthy controls during an episodic memory task including the learning of 20 pairs of items, followed by a 20-minute delayed recall and a recognition task. Prior to recognition, participants rated their ability to recognize each nonrecalled word among 4 items. This episodic FOK measure served to compare predictions of future recognition performance and actual recognition performance. Furthermore, a subjective measure of metamemory, the Metamemory In Adulthood (MIA) questionnaire, was completed by patients and controls. This assessment of alcoholic patients’ metamemory profile was accompanied by an evaluation of episodic memory and executive functioning. Results: FOK results revealed deficits in accuracy, with the alcoholic patients providing overestimations. There were also links between FOK inaccuracy, executive decline, and episodic memory impairment in patients. MIA results showed that although alcoholics did display memory difficulties, they did not differ from controls on questions about memory capacity. Conclusions: Chronic alcoholism affects both episodic memory and metamemory for novel information. Patients were relatively unaware of their memory deficits and believed that their memory was as good as that of the healthy controls. The monitoring measure (FOK) and the subjective measure of metamemory (MIA) showed that patients with chronic alcoholism overestimated their memory capacities. Episodic memory deficit and executive dysfunction would explain metamemory decline in this clinical population.

Objective Post-traumatic behavioral disorders are a serious challenge for social participation of brain-injured people. Quality of life in the families is affected by these troubles. Recently, SOFMER recommends families’ information. Objective Create a training workshop, to families and health professionals, pooling their expertise. Materials/Patients and methods Analysis of previous studies results, a quantitative one (130 brain-injured people and their families), a qualitative one and using interviews (30). Creation of the training workshop, using studies results and analyzing information guides already created. Results Conducting a training workshop in two days. First day includes professionals and Union of Family Associations vice-president oral presentations around three themes: – how to explain behavioral disorders? – how to treat them? – how to improve care pathways and the quality of life? A professional actor animated the second day. Aim was to consider that professional knowledge does not prevail over families’ knowledge. Exchanging of opinion and acting (from scenarios created by participants) are used all over the session. A multimedia support is available, gathering interventions, video presentations and links to interesting Internet. Discussion/Conclusion Training workshop and multimedia support are being improved. Immediate participant evaluations are all positive, but effectiveness evaluation cannot be performed at this date. However, it corresponds to SOFMER recommendations. It can be provided to any team wishing it.

The purpose of this study was to examine executive functioning in patients with Huntington’s disease using an arithmetic word-problem-solving task including eight solvable problems of increasing complexity and four aberrant problems. Ten patients with Huntington’s disease and 12 normal control subjects matched by age and education were tested. Patients with Huntington’s disease performed the solvable problems significantly worse than the normal control subjects, but there was no difference in performance between the two groups in inhibiting aberrant problems. These results suggest that early Huntington’s disease patients exhibit a precocious impairment in their ability to plan the resolution of complex arithmetic word problems without deficit in their ability to eliminate aberrant problems. This dissociation of performance fits with what we have found in such patients using script-sequencing tasks ( Allain et al., 2004 ) and with neuropsychological data obtained by Waltkins et al. (2000) . These results are consistent with what is known about the neuropathological progression of Huntington’s disease in which neuronal loss progresses in a dorso-to-ventral direction and with what was shown in patients with circumscribed frontal lobe damage. In these patients, impairments in planning solvable word problems were more frequent when lesions were in the lateral prefrontal regions.

International audience; Objective: To compare the expectations of patients with brain injury (TBI) entering a post-acute programme to the recommendations made at the end.Design: Retrospective study (1997 and 2009).Intervention: This 12-week post-acute programme included ecological multidisciplinary assessment of physical and cognitive disabilities, independence in activities of daily living and work abilities. Recommendations made at the conclusion of the programme included advice regarding the ability to work in an unsheltered or a sheltered environment and possible social activities.Results: Two hundred and forty patients participated. The main objective of 95.8% was return-to-work: 93.7% expected a normal work environment, 2.1% considered a sheltered environment and 4% entered the programme with the aim of improving social abilities and integration in the community. The recommendations included return-to-work in 68.3% of cases, in an unsheltered environment in 44.2% and in a sheltered environment in 24.1% and advice for contact with social services in order to achieve better social integration in 31.7%. There was a discrepancy between expectations and recommendations in half of the cases.Conclusion: The discrepancy between patients’ expectations and recommendations is in part due to the cognitive disorders; long-term rehabilitation programmes should focus on this issue.

International audience; Recent and convergent studies in neuropsychology have suggested the importance of frontal regions to the integrity of a number of functions such as metamemory capacities, executive functions, and social skills (Theory of Mind: ToM). In this original work, following Stuss et Anderson (2004), we assume a link between disturbances of these functions. We proposed to 16 frontal patients and 20 matched healthy subjects a protocol designed to test metamemory, ToM and executive functions in order to analyze the relations between disturbances of self-awareness (metamemory) and awareness of others (ToM), and cognitive control (executive functions). Our results confirm the importance of frontal lobes on these capacities. No correlation was found between measures of metamemory, measures of ToM and executive scores. The observation of individual profiles emphasizes the existence of dissociations between self awareness and consciousness of the others, and between thesetwo forms of metacognitive control and the executive functioning. These results confirm the importance to engage more studies combining aspects of ToM, metacognition and executive control, to better understand the organization and architecture of the functions supported by frontal lobe.; Des travaux récents et convergents en neuropsychologie suggèrent l’importance des régions frontales pour l’intégrité d’un certain nombre de fonctions telles que les capacités métamnésiques, exécutives et les compétences en cognition sociale (théorie de l’esprit: TDE). Dans ce travail original, nous faisons l’hypothèse d’un lien entre les perturbations de ces différentes fonctions dans le cadre de la conception hiérarchisée de la conscience de Stuss et Anderson (2004). Nous avons proposé à 16 patients frontaux et 20 sujets sains appariés un protocole d’étude de la métamémoire, de la TDE et des fonctions exécutives cognitives afin d’examiner, chez les mêmes participants, les perturbations de la conscience de soi (métamémoire) et de la conscience de l’autre (TDE), le tout en lien avec les troubles du contrôle cognitif. Les résultats de nos analyses intergroupes permettent de confirmer la sensibilité de la plupart des tâches aux lésions frontales (Stroop, Hayling, Tour de Londres, six éléments, MCST et Brixton). L’analyse corrélationnelle ne permet pas de retrouver, chez les patients, des liens entre les mesures de métamémoire, de TDE et de fonctionnement exécutif cognitif. L’analyse des profils individuels souligne l’existence de dissociations entre connaissance de soi et de l’autre, mais aussi entre ces deux formes de métaconnaissance et les mécanismes de contrôle exécutif. Ces résultats confirment l’importance d’étudier plus précisément les différents niveaux de perturbation du fonctionnement frontal pour mieux comprendre l’organisation et l’architecture des fonctions supportées par le lobe frontal.

International audience; BACKGROUND: Patients' personal investment and readiness to change have proved to be a prerequisite for the successful treatment of alcohol addiction. The aim of this study was to determine the contribution of cognitive functions to the motivation process to abandon maladjusted behavior in favor of a healthier lifestyle. METHODS: An adapted version of the "readiness to change" questionnaire was completed by 31 alcohol-dependent patients after detoxification and at alcohol treatment entry. This tool is designed to assess the 3 main stages of motivation to change regarding alcohol consumption: precontemplation (substance abuse and no intention to stop drinking), contemplation (strong intention to change habits but ambivalent behavior), and action (cessation of excessive alcohol consumption and behavioral changes for healthier habits) stages. Patients and 37 healthy controls also underwent an extensive neuropsychological battery including episodic memory, metamemory, executive functions, and decision-making assessment. RESULTS: When alcohol-dependent patients were considered as a group, the mean score on the action subscale was significantly higher than the precontemplation and contemplation ones. Nevertheless, when the stage of change reached by each patient was considered individually, we found that some alcohol-dependent patients were still in the earlier precontemplation and contemplation stages. Stepwise regression analysis revealed links between impaired memory and executive functions and low motivation, and between good decision-making skills and high motivation. CONCLUSIONS: Our results suggest that a set of complementary cognitive abilities is needed to achieve awareness and resolve ambivalence toward alcohol addiction, which is essential for activating the desire to change problematic behavior.

The aim of the present study was to determine whether monitoring measures are differentially disturbed in dysexecutive patients after frontal lesions. Twelve dysexecutive patients and 12 healthy controls were administered a paired-associates learning task. Their performances on recall prediction, judgment-of-learning (JOL), and feeling-of-knowing judgment (FOK) were then compared. The results revealed that the two groups differed only on accuracy measures of the FOK paradigm. The study of the overall correlations between the three measures of metamemory revealed a significant relation between recall prediction and accuracy measures of the JOL. We failed to find any significant correlation with the accuracy measures of the FOK. Taken together, our data confirm that metamemory experience is not a unitary construct but rather a group of distinct and quite independent mechanisms.

A particularly important aspect of executive functioning involves the ability to form and carry out complex plans, that is to say planning. This study aimed to investigate planning in 18 older and 16 younger normal participants 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 participants 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 participant is simply required to follow a concrete externally imposed strategy to reach the locations to visit (execution level). The two-way ANOVAs mainly showed more difficulties in elderly adults than in younger adults, more difficulties in formulation level than in execution level, and lastly a greater difference between formulation and execution in older participants than in younger adults. These results suggest that elderly participants have some problems developing logical strategies whereas they are able to execute complex predetermined plans.

International audience; Cette synthèse aborde la question de la cognition sociale (théorie de l’esprit en particulier), du traitement des émotions et de la métacognition dans une perspective de neuropsychologie clinique. Nous nous attardons sur les études examinant les relations qu’entretiennent ces différents aspects du comportement humain avec les fonctions exécutives et les structures frontales. Lesrésultats rapportés montrent que les liens potentiels entre la théorie de l’esprit et le fonctionnement exécutif font encore beaucoup débat, et que l’étude des relations entre théorie de l’esprit et lobe frontal mérite d’être affinée. Leslésions frontales perturbent le traitement des émotions, mais les relations entre perturbation des fonctions exécutives et troubles du traitement des émotions restent inexplorées. Lamétacognition a été peu étudiée chez les patients dysexécutifs par lésions frontales, si ce n’est au travers de quelques études sur la métamémoire qui montrent que les patients frontaux ont globalement tendance à surestimer leurs performances. Cette surestimation ne semble pas nécessairement procéder d’un déficit exécutif, d’une incapacité de jugement, ni d’une méconnaissance du fonctionnement mnésique normal et pathologique. Ilne s’agit pas non plus d’une difficulté d’utilisation de connaissances. Deplus, les différentes mesures métamnésiques obtenues chez les patients frontaux corrèlent peu entre elles, indiquant qu’elles engagent probablement des processus du contrôle métamnésique relativement indépendants qu’il conviendrait de spécifier. Enfin, il faudra aussi vérifier, avec des malades porteurs de lésions frontales et/ou de syndromes dysexécutifs, les propositions théoriques les plus récentes voulant que les concepts de théorie de l’esprit et de métacognition soient finalement assez proches.