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7 results

  • Working memory multicomponent model outcomes in individuals with traumatic brain injury: Critical review and meta-analysis

  • Bar Lambez, Eli Vakil, Philippe Azouvi, Claire Vallat-Azouvi
  • Journal:
    Journal of the International Neuropsychological Society / Volume 30 / Issue 9 / November 2024
    Published online by Cambridge University Press:
    11 November 2024, pp. 895-911
    • Article
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  • Objective:

    Traumatic Brain Injury (TBI) often leads to cognitive impairments, particularly regarding working memory (WM). This meta-analysis aims to examine the impact of TBI on WM, taking into account moderating factors which has received little attention in previous research, such as severity of injury, the different domains of Baddeley’s multi-component model, and the interaction between these two factors, as well as the interaction with other domains of executive functions.

    Method:

    Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review and meta-analysis searched Google Scholar, PubMed, and PsycNET for studies with objective WM measures. Multiple meta-analyses were performed to compare the effects of TBI severity on different WM components. Twenty-four English, peer-reviewed articles, mostly cross-sectional were included.

    Results:

    TBI significantly impairs general WM and all Baddeley’s model components, most notably the Central Executive (d’ = 0.74). Severity categories, mild-moderate and moderate-severe, were identified. Impairment was found across severities, with “moderate-severe” demonstrating the largest effect size (d’ = 0.81). Individuals with moderate-severe TBI showed greater impairments in the Central Executive and Episodic Buffer compared to those with mild-moderate injury, whereas no such differences were found for the Phonological Loop and Visuospatial Sketchpad.

    Conclusions:

    These findings enhance our understanding of WM deficits in varying severities of TBI, highlighting the importance of assessing and treating WM in clinical practice and intervention planning.

  • Impact of Combined Transcranial Direct Current Stimulation and Speech-language Therapy on Spontaneous Speech in Aphasia: A Randomized Controlled Double-blind Study

  • Elodie Guillouët, Mélanie Cogné, Elisabeth Saverot, Nicolas Roche, Pascale Pradat-Diehl, Agnès Weill-Chounlamountry, Vanessa Ramel, Catherine Taratte, Anne-Gaëlle Lachasse, Jean-Arthur Haulot, Isabelle Vaugier, Frédéric Barbot, Philippe Azouvi, Sophie Charveriat
  • Journal:
    Journal of the International Neuropsychological Society / Volume 26 / Issue 1 / January 2020
    Published online by Cambridge University Press:
    27 January 2020, pp. 7-18
  • Objective:

    Aphasia recovery depends on neural reorganization, which can be enhanced by speech-language therapy and noninvasive brain stimulation. Several studies suggested that transcranial direct current stimulation (tDCS) associated with speech-language therapy may improve verbal performance evaluated by analytic tests, but none focused on spontaneous speech. We explored the effect of bihemispheric tDCS on spontaneous speech in patients with poststroke aphasia.

    Methods:

    In this multicentric controlled randomized cross-over double-blind study, we included 10 patients with poststroke aphasia (4 had aphasia >6 months and 6 with aphasia <6 months). We combined the sessions of speech-language therapy and bihemispheric tDCS (2 mA, 20 min). After three baseline speech evaluations (1/week), two different conditions were randomly consecutively proposed: active and sham tDCS over 3 weeks with 1 week of washout in between. The main outcome measure was the number of different nouns used in 2 min to answer the question “what is your job.”

    Results:

    There was no significant difference between conditions concerning the main outcome measure (p = .47) nor in the number of verbs, adjectives, adverbs, pronouns, repetitions, blank ideas, ideas, utterances with grammatical errors or paraphasias used. Other cognitive functions (verbal working memory, neglect, or verbal fluency) were not significantly improved in the tDCS group. No adverse events occurred.

    Conclusion:

    Our results differed from previous studies using tDCS to improve naming in patients with poststroke aphasia possibly due to bihemispheric stimulation, rarely used previously. The duration of the rehabilitation period was short given the linguistic complexity of the measure. This negative result should be confirmed by larger studies with ecological measures.

  • Working memory after severe traumatic brain injury

  • CLAIRE VALLAT-AZOUVI, THOMAS WEBER, LUDOVIC LEGRAND, PHILIPPE AZOUVI
  • Journal:
    Journal of the International Neuropsychological Society / Volume 13 / Issue 5 / September 2007
    Published online by Cambridge University Press:
    14 August 2007, pp. 770-780

  • The aim of the present study was to assess the functioning of the different subsystems of working memory after severe traumatic brain injury (TBI). A total of 30 patients with severe chronic TBI and 28 controls received a comprehensive assessment of working memory addressing the phonological loop (forward and backward digit span; word length and phonological similarity effects), the visuospatial sketchpad (forward and backward visual spans), and the central executive (tasks requiring simultaneous storage and processing of information, dual-task processing, working memory updating). Results showed that there were only marginal group differences regarding the functioning of the two slave systems, whereas patients with severe TBI performed significantly poorer than controls on most central executive tasks, particularly on those requiring a high level of controlled processing. These results suggest that severe TBI is associated with an impairment of executive aspects of working memory. The anatomic substrate of this impairment remains to be elucidated. It might be related to a defective activation of a distributed network, including the dorsolateral prefrontal cortex. (JINS, 2007, 13, 770–780.)

  • 10 - Anosognosia and denial after right hemisphere stroke

  • Edited by Olivier Godefroy, Université de Picardie Jules Verne, Amiens, Julien Bogousslavsky, Université de Lausanne, Switzerland
  • Book:
    The Behavioral and Cognitive Neurology of Stroke
    Published online:
    10 October 2009
    Print publication:
    18 January 2007, pp 198-214

  • Summary

    General presentation of anosognosia

    Anosognosia is a puzzling condition. It refers to patients suffering from various neurological impairments who deny or lack awareness of their deficits, although these deficits may have serious consequences in their everyday life. Studying anosognosia is important for two reasons. The first one is a practical reason. Indeed, as pointed out by Heilman (1991), anosognosia is not a trivial problem. It may impair patients' motivation to engage in a rehabilitation program, and anosognosia has repeatedly been found associated with poor functional recovery from stroke. But studying anosognosia is also of great theoretical importance, as it may help our understanding of the complex relationships between brain injury and various forms of consciousness. However, despite this, anosognosia remains one of the least studied of the major neuropsychological symptoms after stroke, and its pathophysiology is still very poorly understood.

    Detailed historical review of anosognosia have been published recently (Bisiach and Geminiani, 1991; Prigatano and Schacter, 1991). First observations of patients with impaired awareness of neurological deficits were reported in the late nineteenth century by von Monakow in 1885 and by Anton in 1889 in cases of cortical blindness. It seems that Pick, in 1898, was actually the first to report unawareness of left hemiplegia, but it was Joseph Babinski who first coined the term “anosognosia,” and his contribution, at a meeting held by the French Neurological Society on June 11, 1914, remains a landmark in the field (Babinski, 1914).

  • Script knowledge after severe traumatic brain injury

  • FABIENNE CAZALIS, PHILIPPE AZOUVI, ANGELA SIRIGU, NATHALIE AGAR, YVES BURNOD
  • Journal:
    Journal of the International Neuropsychological Society / Volume 7 / Issue 7 / November 2001
    Published online by Cambridge University Press:
    11 January 2002, pp. 795-804

  • Severe diffuse traumatic brain injury (TBI) may impair the performance of daily-life complex activities. The aim of the present study was to assess whether these difficulties are related to a representational impairment of action knowledge. Two tasks requiring the manipulation of scripts were used. The first (script reconstitution) required subjects to sort cards describing actions belonging to 4 different scripts, presented in a random order. The second (script generation) required subjects to generate actions belonging to a given script. The results showed that TBI patients had preserved access to goal representation and action knowledge. However, they demonstrated (1) significant impairments when they had to deal with simultaneous competing sources of information and (2) a lack of inhibitory control on routine overlearned skills. Patients' performance was significantly correlated with behavioral modifications in everyday life. These data suggest that action impairment in severe TBI patients cannot be attributed to an impairment of action knowledge per se. As previously suggested by Schwartz et al., a restriction of limited-capacity processing resources may account for the observed deficits. (JINS, 2001, 7, 795–804.)