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Progressive neurocognitive pathologies frequently alter the architecture of sleep with: advanced sleep phase or phase delay, sleep fragmentation, decrease of slow-wave sleep, REM sleep, nocturnal agitation and wandering or even complete reversal of the nycthemeral rhythm. This has a clear impact on the health and quality of life of the patient. Hospitalization increases the risk of sleep disturbances due to inactivity, some sensory deprivation and daytime hypovigilance. The therapeutic gardens offer in an attractive, sensorially stimulating setting and exposed to natural light, the possibility of an adapted physical exercise. Their impact on the quality and quantity of sleep in cognitive-behavioral units has been evaluated in an exploratory manner. The hypnogram of two groups of 30 patients was compared depending on whether they used the garden (weather permitting, in summer) or not (in winter). The results show that the patients who use the garden are significantly more active during the day, have a longer nighttime sleep duration and are less restless at night. In addition, patients who use and walk longer in the garden benefit from an increase in their sleep time. In view of their multiple interests, therapeutic gardens, if they meet validated design criteria, should be integrated more widely into establishments welcoming people with neurocognitive diseases.

Purpose: Digital PET cameras markedly improve sensitivity and spatial resolution of brain 18 F-FDG PET images compared to conventional cameras. Our study aimed to assess whether specific control databases are required to improve the diagnostic performance of these recent advances., Methods: We retrospectively selected two groups of subjects, twenty-seven Alzheimer's Disease (AD) patients and twenty-two healthy control (HC) subjects. All subjects underwent a brain 18 F-FDG PET on a digital camera (Vereos, Philips®). These two group (AD and HC) are compared, using a Semi-Quantitative Analysis (SQA), to two age and sex matched controls acquired with a digital PET/CT (Vereos, Philips®) or a conventional PET/CT (Biograph 6, Siemens®) camera, at group and individual levels. Moreover, individual visual interpretation of SPM T-maps was provided for the positive diagnosis of AD by 3 experienced raters., Results: At group level, SQA using digital controls detected more marked hypometabolic areas in AD (+ 116 cm 3 at p < 0.001 uncorrected for the voxel, corrected for the cluster) than SQA using conventional controls. At the individual level, the accuracy of SQA for discriminating AD using digital controls was higher than SQA using conventional controls (86% vs. 80%, p < 0.01, at p < 0.005 uncorrected for the voxel, corrected for the cluster), with higher sensitivity (89% vs. 78%) and similar specificity (82% vs. 82%). These results were confirmed by visual analysis (accuracies of 84% and 82% for digital and conventional controls respectively, p = 0.01)., Conclusion: There is an urgent need to establish specific digital PET control databases for SQA of brain 18 F-FDG PET images as such databases improve the accuracy of AD diagnosis.

Objective: To assess progression of semantic loss in early stages of cognitive decline using semantic and letter fluency performance, and its relation with Alzheimer's disease (AD)-specific neurodegeneration using longitudinal multimodal neuroimaging measures., Methods: Change in verbal fluency was analyzed among 2261 non-demented individuals with a follow-up diagnosis of no mild cognitive impairment (MCI), amnestic MCI (aMCI), non-amnestic MCI (naMCI), or incident dementia, using linear mixed models across 4 years of follow-up, and relations with magnetic resonance imaging (MRI; n = 1536) and 18 F-fluorodeoxyglucose brain positron emission tomography ( 18 F-FDG-PET) imaging (n = 756) using linear regression models across 2 years of follow-up., Results: Semantic fluency declined-fastest in those at higher risk for AD (apolipoprotein E [APOE] e4 carriers, Clinical Dementia Rating score of .5, aMCI, or incident dementia)-while letter fluency did not except for those with incident dementia. Lower baseline semantic fluency was associated with an increase in white matter hyperintensities and total mean cortical thinning over time, and regionally with less hippocampal volume as well as more cortical thinning and reduced 18 F-FDG-PET uptake in the inferior parietal lobule, entorhinal cortex, isthmus cingulate, and precuneus-posterior cingulate area. In contrast, baseline letter fluency was not associated with change in total nor regional neurodegeneration. Whole-brain neurodegeneration over time was associated with faster decline in both fluencies, while AD-specific regions were associated with a faster rate of decline in semantic but not letter fluency., Interpretation: This study provides strong evidence of distinctive degeneration of semantic abilities early on in relation to both cognitive decline and AD-specific neurodegeneration., Competing Interests: The authors have no relevant conflicts of interest or financial or other nonprofessional benefits to disclose that could bias the authors in the conduct of the reported work., (© 2020 The Authors. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Introduction: Subjective cognitive complaints may be a signature of preclinical stage Alzheimer's disease. However, the link between subjective cognitive and non-cognitive complaints and brain alterations remains unclear., Methods: The relationship between cognitive and non-cognitive complaints and brain biomarkers, measured by structural magnetic resonance imaging, was investigated in 2056 participants of the MEMENTO cohort of outpatients, who were dementia-free at baseline. We assessed whether the cognitive status at inclusion or the presence of the apolipoprotein E gene variant ( APOE ) ε4 could modulate the association between the intensity of complaints and brain lesions., Results: Smaller hippocampal volume was associated with higher memory complaints and discomfort in daily life. In APOE ε4 carriers, smaller whole-brain white matter and gray matter volumes and gyrification indices in several regions of interest of the parietal and temporal lobes, in the entorhinal and the para-hippocampal gyrus, were associated with higher memory complaint score., Conclusions: The intensity of subjective complaints in not only memory but discomfort in daily life was associated with brain degeneration markers. The presence of APOE ε4 modulated the relationships between subjective memory complaints and brain alterations., Competing Interests: The authors declare that they have no competing interests., (© 2020 The Authors. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring published by Wiley Periodicals, Inc. on behalf of Alzheimer's Association.)

Background: The environment of patients with Alzheimer's disease and related disorders (ADRD) intensifies the consequences of cognitive impairment and exacerbates behavioral problems if inappropriate or, conversely, mitigate these problems if its design is tailored to the needs of these persons., Objective: We evaluate the impacts of hospitalization and of a specific healing garden on self-consciousness which represent a central impairment in ADRD. The self-consciousness questionnaire (SCQ), validated for its assessment at mild to moderate phases of the disease, explores the dimensions of personal identity, awareness of cognitive deficiencies, self-assessment of affective state, awareness of body representation, prospective memory, capacity for introspection, and moral judgments., Methods: After having verified, by means of a preliminary study, its feasibility to the more advanced stages of the disease, this questionnaire allowed assessment of the impact of the environment by comparing, in routine care, patients hospitalized in a cognitive-behavioral unit who solely remain indoors with others who use the Art, Memory and Life healing garden., Results: A significant decrease in SCQ due to an increase in anosognosia during hospitalization was observed in the group that remained indoors. For the group using the garden, a positive effect on overall SCQ score was observed, as a result of a significant improvement in body representation as the driving parameter., Conclusion: Factors that are grounded in the hypotheses that spearheaded its conception, such as sensory enrichment, familiarity, contact with nature, scaffolding role for cognitive functions, supportive effect for social interactions, and the "Nancy hypotheses of beauty", thus contribute to their validation.

Background: Atypical cerebrospinal fluid (CSF) patterns, involving an increase in the concentration of phosphorylated-tau (P-tau) proteins but normal amyloid-β concentration, are not uncommon in patients with mild neurocognitive disorders and suspected Alzheimer's disease (AD). In these conditions, however, AD diagnosis may be ruled out in the absence of any amyloid deposition at positron-emission tomography (PET). This pilot cross-sectional study was aimed to determine whether this negativity of amyloid PET can be predicted by CSF profiles in such patients., Methods: Twenty-five patients (73 [68-80] years, 10 women) with mild neurocognitive disorders, suspected AD and an increase in the CSF concentration of P-tau proteins but normal Aβ42 concentration and Aβ42/Aβ40 ratio were prospectively included and referred to a 18 F-florbetaben PET. The latter was considered as definitively negative with the conjunction of both visual (brain amyloid plaque load score) and quantified (standard uptake value ratios) criteria. Predictors of a negative PET were searched among current CSF biomarkers (Aß42, Aß40, T-tau, P-tau, Aß42/Aß40, Aß42/p-tau)., Results: Amyloid PET was negative in 15 patients (60%) with a CSF Aß42 concentration being the sole independent predictor of this negativity. The criterion of an Aß42 concentration in the very high range (> 843 pg/mL), observed in 60% (15/25) of the study patients, was associated with a negative amyloid PET in 93% (14/15) of cases., Conclusions: In mild neurocognitive disorders patients with suspected AD and showing an increase in CSF P-tau protein level, amyloid PETs are commonly negative, when Aß42 concentration is in the very high range. In such case, AD diagnosis based on biomarkers can be ruled out with reasonable certainty, without the need for additional CSF second-line assays or results from amyloid PET.

The discovery of time cells has expanded our knowledge in the field of spatial and temporal information coding and the key role of the hippocampus. The internal clock model complemented with the attentional gate model allows a more in-depth understanding of the perception of time. The motor representation of duration is ensured by the basal ganglia, while the cerebellum synchronizes short duration for the movement. The right prefrontal cortex seemingly intervenes in the handling of temporal information in working memory. The temporal lobe ensures the comparison of durations, especially the right lobe for the reference durations and the medial lobe for the reproduction of durations in episodic memory. During normal aging, the hypothesis of slowing of the temporal processor is evoked when noting the perception of the acceleration of the passage of time that seemingly occurs with advancing age. The various studies pertaining specifically to time cognition, albeit heterogeneous in terms of methodology, attest to the wide-ranging disturbances of this cognitive field during the course of numerous disorders, whether psychiatric - depression and schizophrenia notably - or neurological. Hence, perturbations in temporality are observed in focal brain lesions and in subcortical disorders, such as Parkinson's disease or Huntington's chorea. Alzheimer's disease represents a particularly fertile field of exploration with regard to time cognition and temporality. The objectified deconstruction of temporal experience provides insights into the very processes of temporality and their nature: episodic, semantic and procedural. In addition to exploration based on elementary stimuli, one should also consider the time lived, i.e. that of the subject, to better understand cognition as it relates to time. While the temporal dimension permeates the whole cognitive field, it remains largely neglected: integration of a genuine time cognition and temporality clinic in daily practice remains to be implemented.

Objective: Episodic and semantic processes are involved in temporality used in daily life. Episodic memory permits one to place an event on the time axis, while semantic memory makes us aware of the time segmentation and its symbolic representation. Memory of the knowledge connected to the passing of time is materialized on the calendar and can be seen symbolically on the dial of a clock. In AD, semantic memory processes are preserved longer than processes related to episodic memory. We wonder whether the specific field of knowledge about time is altered during AD., Methodology: We validated a specific evaluation with a control group (354 healthy subjects). Then we applied this battery to assess AD patients to appreciate the feasibility of this tool for this population. We then compared 22 AD patients with a control group matched for age, sex and educational level. Our clinical scale of temporal semantic knowledge consists of four parts: (a) hour reading with a.m. and p.m. hours; (b) using a clock: 12 clock faces with the hour numbers already placed: the patient draws hour and minute hands for various hours; (c) temporal segmentation: exploration of the knowledge on daytime scale and of the calendar; (d) time duration estimation: calculate how long the interview has lasted after indicating the time of its beginning and its end, then the time between 10.40 to 12.00., Results: While age and educational level had an influence on all the scores, in the two groups control and patients, gender did not. Temporal segmentation, independent of the cultural level, revealed the best acquired knowledge in our control population. All the scores differentiated patients from control subjects. The temporal semantic knowledge correlated with the AD severity seemed to be correlated with the attention, verbal comprehension, and some components of executive functions, but was not related to the clock drawing test result. Depression did not have any influence on this scale in our AD group., Discussion: The temporal semantic knowledge clinical scale shows differential alterations, notably in hour reading and using a clock, and less in temporal segmentation., Conclusion: Temporal semantic knowledge is altered in AD. The diagnosis and follow-up of these alterations allow professionals and caregivers to consider adaptations of the patient's environment according to their needs., (Copyright © 2013 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Cognitive-behaviour units are specialised units within follow-up and rehabilitation care services for people suffering from Alzheimer's disease. These units were created in response to measure 17 of the 3rd Alzheimer's Plan. To stabilise behavioural disorders, as part of a non pharmacological care plan, the therapeutic garden is a useful care tool. This article presents an original initiative in Nancy.

The French Alzheimer Plan 2008-2012 anticipates the implementation of new Units specialized in cognitive rehabilitation and psycho-behavioral therapy of Alzheimer's disease (AD) patients. Conceived for AD and other dementia patients of all ages, their objectives are to propose a cognitive rehabilitation program, to prevent or treat psycho-behavioral crises, and to provide support and educational therapy to the family and professional caregivers, in order to ease the patient's return to his or her previous way of life. Studies on green spaces and healing gardens in health-care settings have revealed objective and measurable improvements in the patient's well-being. The Plan officially stipulates for the first time the need to make healing gardens an integral part of these Units, but it does not provide specific recommendations or criteria for implementing such gardens. Although green spaces and gardens are available in many French Care Units, they are rarely specifically adapted to the needs of AD patients. In Nancy, the Art, Memory and Life garden, a specific concept guided by a neuropsychological approach, was developed and complemented by an artistic vision based on cultural invariants. The main objective of this article is to describe the various steps of the process that led to the creation of this garden: the collection of experiences and information by a pilot group, surveys of patients, visitors, and caregivers before and after establishment of the garden, and implementation of a multi-professional group project. The specifications, the organizational criteria, the therapeutic project, and the criteria for the conception of such a garden stemming from our clinical experience with the Art, Memory and Life garden in Nancy, are described herein. We also present the first assessment following the implementation of the project.

The French Alzheimer plan anticipates new specialized structures for cognitive rehabilitation and psycho-behavioural therapy of Alzheimer's patients: the cognitive-behavioural units as follow-care units, the units of reinforced hospitalization inside the long term care units and the adapted activities units. this plan indicates the need to make healing gardens integral parts of these units. The benefits of green space in urban environments has been demonstrated with regards to physical, psychological and sociological effects and similarly studies in hospitals have revealed objective and measurable improvements of patients well being. Although green spaces and gardens are available in many French care units, they are rarely specifically adapted to the needs of Alzheimer's patients. For the garden "art, memory and life" a specific concept guided by a neuropsychological approach was developed, complemented by an artistic vision based on cultural invariants. It is already used in the frame of non-pharmacological therapies to improve symptoms such as deambulation, sleep disorders, apathy and aggressive behaviors. Based on the literature, and our experience and research, recommendations for the design of such gardens dedicated to Alzheimer's patients can be proposed. Beyond taking into account obvious aspects relating to security, allowing for free access, a careful design of walk-ways and a conscious choice of plants is needed. A systematic analysis of the existing green spaces or garden must be conducted in order to pinpoint the weakness of the space and identify the potential for developing it into a real healing garden. Evaluation of adapted questionnaires for users and professionals allow to establish a list of requirements combining both user requests and therapeutic needs as basis for the design of the garden as well as to evaluate during the course of the project, whether the needs of the various stakeholders have been met or if adjustments are necessary.

Five patients developed neurological adverse effects as they were treated with amiodarone for 2 to 18 months. The daily maintenance dose did not exceed 400 mg. The neurological manifestations included tremor, ataxia, peripheral neuropathy, dyskinesia, myoclonic jerks, extrapyramidal hypertony, and altered mental status. These side effects resolved within 3 days to 3 months after amiodarone withdrawal. Advanced age, renal failure, diabetes mellitus, and alcoholism seemed to be risk factors for development of amiodarone neurotoxicity. Both peripheral and central nervous systems are involved in these amiodarone-induced complications.

Three cases of central nervous system involvement in Waldenström's macroglobulinemia (Bing Neel's syndrome) are reported. Such cases are unusual and have a poor prognosis. One patient received chemotherapy including BCNU, cyclophosphamide, vincristine, melphalan and prednisolone, which was followed by a dramatic improvement. The pathogenesis of Bing Neel's syndrome is discussed.

Long latency auditory evoked potentials were recorded in 50 patients with Parkinson's disease, some case were also investigated by the Rapid Evaluation of Cognitive Functions test (RECF) and Trail Making A test (TMA). Latencies of P2, N2 and P300 waves were longer in the parkinsonian group than in a control group matched for age. Latencies of N2 and P300 waves were correlated significantly with scores for RECF and TMA presumed to be sensitive to organic brain lesions. On the other hand no significant correlation was found between RECF and P1 and P2 latencies. In addition, correlation was lacking between Verbal Automatism test scores, presumed to be resistant to organic brain lesions, and P300 wave latencies. Cognitive evoked potential (CEP) latency increases with age in normal subjects. In the parkinsonian group the coefficient of correlation between these two factors was lower but still significant. The parkinsonian patients with dementia as defined by DSM III criteria, or an RECF score of less than 46, showed longer N2 and P300 latencies but no significant difference in N1 and P2 latencies. In contrast, comparison of P300 and N2 wave latencies in depressed and non-depressed parkinsonian patients failed to show any significant difference. The bilateral akinetic forms had marked lengthening of P300 wave latencies and a lower TMA score. Neither the duration of the disease, type of treatment, duration of L-Dopa therapy significantly influenced the latency of cognitive event-related potentials.

A 11 cases study of hematoma of the iliacus muscle underlines better results obtained by C.T. Scanner compared to those of ultrasonography examination in term of definite diagnoses. Comparison of density values and repeated examination were useful to assert diagnosis and to appreciate the course of the illness. Only C.T. Scanner was able to show which portion of the muscle was concerned. Authors correlated the C.T. Scanner results to the nature of the entrapment neuropathy clinically found: an isolated femoral nerve palsy or association with an obturator nerve dysfunction.

The authors report on the case of a young woman, seven months gone, with an history of sudden onset of successive lobar intracerebral hematomas. They revealed a Rendu-Osler-Weber disease. The mechanism is discussed.