Dysexecutive disorders and their diagnosis: A position paper

Although executive function disorders are among the most prevalent cognitive impairments a consensus on diagnostic criteria has yet to be reached. With a view to harmonizing these criteria, the present position paper (i) focuses on the main dysexecutive disorders, (ii) examines recent approaches in both the behavioral and cognitive domains, (iii) defines diagnostic boundaries for frontal syndrome, (iv) reports on the frequency and profile of the executive function disorders observed in the main brain diseases, and (v) proposes an operationalization of diagnostic criteria. Future work must define the executive processes involved in human adaptive behavior, characterize their impairment in brain diseases, and improve the management of these conditions (including remediation strategies and rehabilitation).

The effect of contextual auditory stimuli on virtual spatial navigation in patients with focal hemispheric lesions

Topographical disorientation is a frequent deficit among patients suffering from brain injury. Spatial navigation can be explored in this population using virtual reality environments, even in the presence of motor or sensory disorders. Furthermore, the positive or negative impact of specific stimuli can be investigated. We studied how auditory stimuli influence the performance of brain-injured patients in a navigational task, using the Virtual Action Planning-Supermarket (VAP-S) with the addition of contextual ("sonar effect" and "name of product") and non-contextual ("periodic randomised noises") auditory stimuli. The study included 22 patients with a first unilateral hemispheric brain lesion and 17 healthy age-matched control subjects. After a software familiarisation, all subjects were tested without auditory stimuli, with a sonar effect or periodic random sounds in a random order, and with the stimulus "name of product". Contextual auditory stimuli improved patient performance more than control group performance. Contextual stimuli benefited most patients with severe executive dysfunction or with severe unilateral neglect. These results indicate that contextual auditory stimuli are useful in the assessment of navigational abilities in brain-damaged patients and that they should be used in rehabilitation paradigms.

Unilateral hemispheric lesions disrupt parallel processing within the contralateral intact hemisphere: an auditory fMRI study

Evidence from activation studies suggests that sound recognition and localization are processed in two distinct cortical networks that are each present in both hemispheres. Sound recognition and/or localization may, however, be disrupted by purely unilateral damage, suggesting that processing within one hemisphere may not be sufficient or may be disturbed by the contralateral lesion. Sound recognition and localization were investigated psychophysically and using fMRI in patients with unilateral right hemisphere lesions. Two patients had a combined deficit in sound recognition and sound localization, two a selective deficit in sound localization, one a selective deficit in sound recognition, and two normal performance in both tasks. The overall level of activation in the intact left hemisphere of the patients was smaller than in normal control subjects, irrespective of whether the patient's performance in the psychophysical tasks was impaired. Despite this overall decrease in activation strength, patients with normal performance still exhibited activation patterns similar to those of the control subjects in the recognition and localization tasks, indicating that the specialized brain networks subserving sound recognition and sound localization in normal subjects were also activated in the patients with normal performance, albeit to an altogether lesser degree. In patients with deficient performance, on the other hand, the activation patterns during the sound recognition and localization tasks were severely reduced, comprising fewer and partly atypical activation foci compared to the normal subjects. This indicates that impaired psychophysical performance correlates with a breakdown of parallel processing within specialized networks in the contralesional hemisphere.

[Cognitive sequelae following rupture of aneurysms of the anterior communicating artery and the anterior cerebral artery. Retrospective study of 56 cases]

The neuropsychological records of 56 patients operated for clipping were studied. Almost every patient remained autonomous and without invalidating motor defect. The present study was aimed at specifying the type and frequency of neuropsychological sequelae and, to a lesser extent, the role of various pathophysiological factors. A main concern was to examine to what extent and at what post-operative interval the neuropsychological assessment can predict the intellectual and socioprofessional outcome of each individual patient. The neuropsychological assessment performed beyond the acute phase showed evidence of intellectual sequelae in about two thirds of the patients. Only one case of permanent anterograde amnesia was observed, probably due to unavoidable inclusion of a hypothalamic artery in the clip during surgery. Transient anterograde amnesia and confabulations were occasionally observed, generally for less than three weeks. A common finding was impaired performance on memory and/or executive tests. In a minority of patients, language disorders, visuoperceptive and visuoconstructive disabilities were found, probably in relation with hemodynamic changes at distance from the aneurysm. Global impairment of intellectual function was not uncommon in the acute post-operative phase but it evolved in most cases towards a more selective impairment, for instance restricted to executive and memory functions, in the chronic phase. The neuropsychological investigation carried out 4 to 15 weeks post-operatively provided satisfactory information about possible long-lasting intellectual disturbances and professional resumption. In particular, persistent global intellectual impairment, persistent amnesia and confabulations 4-15 weeks post-operative were associated with cessation of professional activity; executive and memory impairment, behavioral disturbances such as those encountered in patients with frontal lobe damage were associated with a decreased probability of full-time employment. Pre- and post-operative angiography were not good predictors of long-term cognitive outcome: normal angiography was not necessarily followed by normal neuropsychological outcome, conversely abnormal angiography could be found together with normal neuropsychological outcome. By contrast, there was a relationship between left-lateralised abnormalities on post-operative angiography and occurrence of language disorders; similarly, there was a relationship between side of craniotomy and type of deficits, that is language disorders versus visuoperceptive-visuoconstructive impairments.

Pathological false alarm rates following damage to the left frontal cortex

In this study we present further data on case JB who developed memory impairment following a ruptured aneurysm of the anterior communicating artery which resulted in damage centered on the frontal cortex. The data reveal the JB's memory impairment is characterized by a recall impairment in which intrusion rates are abnormally high and a recognition deficit characterized by an exceptionally high false alarm rates. A comparison is made between this case and other recent cases involving impairments with a similar etiology. Theoretical interpretations of JB's deficit are also considered.

Further characterization of the executive memory impairment following frontal lobe lesions

In this article we describe a 41-year-old man who, following an operation to repair a ruptured anterior communicating artery aneurysm, manifested the "hallmark" features of a dysexecutive memory impairment. Of particular note was the patient's apparently normal level of recognition memory but impaired recall on tasks matched for difficulty in control subjects. However, further testing revealed that the patient's recognition memory was not normal under all circumstances. Implications of these data for the interpretation and further investigation of the dysexecutive deficit are discussed.

Polyanhydride microsphere formulation by solvent extraction

A novel process based on solvent extraction was developed to produce drug-loaded polyanhydride microspheres for controlled-release applications. The technique consists of adding a chloroform solution of polyanhydride and drug into a stirred silicone oil phase containing suspended droplets of surfactant. No chemical reaction, heating, nor contact with water was required in this process. The microspheres produced were capable of releasing various dyes for prolonged periods of time.

Osmotic water transport through cellulose acetate membranes produced from a latex system

The advisability of a progressive curtailment of organic solvent film coating offers an incentive to develop latex systems. Here, the use of aqueous colloidal dispersions of cellulose acetate, plasticized with water-soluble additives, is proposed as an alternative way to obtain cellulose acetate membranes either by casting or spraying. The osmotic water permeability of both kinds of films was measured, as well as their loss of leachable materials and degree of swelling in a saturated solution of potassium chloride. The permeabilities varied over a wide range depending on the physicochemical properties of the plasticizer and its initial concentration in the latex, and on the conditions for coating (temperature, rate of spraying, and drying duration). High boiling point plasticizers gave more permeable films. Films prepared by casting were found to be sensitive to their sodium dodecyl sulfate content.

Mechanically strong films produced from cellulose acetate latexes

Mechanically strong films, comparable with those obtained from organic solutions, can be produced from cellulose acetate latexes, a new type of dispersion, both by casting and spraying. The prerequisite conditions for high strength, which include choice of water-soluble plasticizers possessing some degree of volatility, are discussed.