L’impact du niveau d’études sur les performances cognitives est largement connu. Aussi, l’évaluation des sujets de bas ou très bas niveau d’études est un réel challenge pour les cliniciens. D’une part, les outils habituellement utilisés dans le bilan du sujet âgé ne sont pas adaptés aux individus analphabètes ou de bas niveau d’éducation, et, d’autre part, les normes nécessaires à l’interprétation des scores cognitifs ne prennent pas suffisamment en considération cette population de bas niveau scolaire. Ainsi, la question que pose ce travail de thèse est de savoir comment optimiser l’évaluation neuropsychologique de ces sujets de bas niveau scolaires. L’objectif poursuivi par la première étude de cette thèse est de déterminer s’il existe un effet propre du fait de savoir lire et écrire indépendamment de celui de la scolarisation. Pour répondre à cette question, nous avons pu accéder aux données recueillies dans la cohorte mexicaine de Coyoacán qui a la particularité d’avoir un échantillon important de sujets n’ayant jamais été scolarisés. Cette première étude a montré que des sujets n’ayant jamais accédé au système éducatif mais ayant des notions rudimentaires de lecture et d’écriture acquises de manière informelle, ont des performances plus élevées à tous les tests considérés, hormis pour le Set test d’Isaacs (IST), que des sujets ne sachant pas lire et écrire. Ainsi, ces résultats illustrent l’effet des capacités de lecture et d’écriture, un effet distinct de l’effet du niveau de scolarisation. Une seconde difficulté à laquelle doivent faire face les cliniciens est l’absence de normes adaptées aux sujets de bas niveau d’études. Ainsi, un travail autour de l’élaboration de normes adaptées aux sujets de bas niveau d’études a été réalisé dans la cohorte de Coyoacán et nous a permis d’élaborer des normes pour le Mini Mental State Examination (MMSE), le Rappel libre/Rappel indicé 16 items (RL/RI-16) et l’IST, jusque-là inexistantes pour la population âgée mexicaine et qui a la particularité de présenter une forte proportion de sujets de bas niveau d’études. Un second travail de normalisation a été réalisé dans la cohorte AMI, une cohorte menée en milieu rural dans le département de la Gironde dans laquelle la proportion de sujets de bas niveaux est plus élevée qu’en population générale, pour un nouveau test de mémoire visuo-spatiale, le test des gobelets pour lequel nous avons également étudié sa validité dans la détection de la démence. Ces normes classiques, corrigées pour des variables démographiques sont essentielles à l’interprétation des scores cognitifs. Dans le même temps, dans le cas de la démence où l’âge et le niveau d’études sont deux facteurs de risque majeurs, cette pratique habituelle de corriger pour ces variables afin d’établir ou de prédire un diagnostic de démence peut être remise en question. Si des travaux antérieurs ont montré que l’utilisation de scores corrigés diminue la qualité de détection de la démence, la dernière étude de cette thèse a montré qu’il en est de même lorsqu’il s’agit de prédire la démence : les sujets qui deviennent déments à court terme sont mieux classés lorsque les scores ne sont pas corrigés que lorsqu’ils sont corrigés pour l’âge et le niveau d’études. Ainsi, loin de régler le vaste problème de l’évaluation du sujet de bas niveau d’études, cette thèse tente d’apporter des éléments pragmatiques au clinicien sous la forme de tests ou de normes adaptées, mais aussi des éléments de réflexion sur l’utilisation de ces scores. / The effect of education on cognitive performances and neuropsychological assessment outcomes has been well documented so far. Indeed, the assessment of cognitive performance of individuals with low and very low educational level remains a major clinical challenge for several reasons. Firstly, conventional cognitive assessment tools used with elderly patients are not suitable for illiterate or poorly instructed individuals. Secondly, traditional norms used to identify strengths and weaknesses of cognitive performance are not sensible enough to detect cognitive impairments among illiterate or scarcely instructed individuals. Therefore, how to improve the neuropsychological assessment of individuals with low formal educational level is the main research question of this doctoral thesis. To adequately answer to this prior question, four studies have been conducted. The aim of the first study presented in this thesis was to investigate the specific effect of literacy acquisition on cognitive performances independently of education. For this work, we used data collected from the Coyoacán study, a Mexican population-based cohort which presents an important sample of uneducated participants. The main finding of this study was that participants who never attended school but counting with informal literacy abilities, presented better performances for all cognitive tests, except for the Isaacs Set test (IST), compared to their uneducated illiterate counterparts. These findings illustrate the specific effect of literacy skills acquisition on cognitive performances independently of the influence of schooling. The lack of adapted comparative norms is the second major challenge of neuropsychological assessment of individuals with low-educational level. Consequently, our second study aimed at establishing comparative norms for the MMSE, the Free and Cued Selective Reminding Test and the IST, three tests widely used for cognitive evaluation in elderly people. Of note, these norms were specifically established for the Mexican elderly population, which presents a high rate of illiteracy and low-educational level. Finally, a third study aiming at establishing comparative norms for a new visuo-spatial memory-test: the goblets test. For this study, we used data collected from the AMI cohort study which is conducted in rural areas in the South-West of France. Within this third study we also studied the validity of this test in detecting dementia illness. These comparative norms are necessary to interpret cognitive scores. However, as age and education are major risk factors for dementia, correcting for these demographic variables to improve the accuracy of detection or prediction of dementia may be questionable. Consistently with other studies showing that dementia detection accuracy is compromised when corrected scores are used; findings of our last study showed that regarding dementia prediction accuracy, participants developing dementia, in the short term, are better classified when using uncorrected scores for age and education than the corrected ones. To conclude, cognitive assessment of elderly individuals with low-educational level remains still a major clinical barrier to correctly diagnose dementia. However, besides providing clinicians with several pragmatic inputs such as cognitive tests and appropriated comparative norms, we believe that our findings will encourage clinical reflection regarding the use of these scores.

PDFには「高橋 由佳子」と記載 / 京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21955号 / 医博第4497号 / 新制||医||1037(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 古川 壽亮, 教授 富樫 かおり / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Many standardized measures of cognition include items that must be seen or heard. Nevertheless, it is not uncommon to overlook the possible effects of sensory impairment(s) on test scores. In the current study, we investigated whether sensory impairments could affect performance on a widely used screening tool, the Montreal Cognitive Assessment (MoCA). Three hundred and one older adults (mean age = 71 years) completed the MoCA and also hearing and vision tests. Half of the participants had normal hearing and vision, 38% impaired hearing, 5% impaired vision, and 7% had dual-sensory impairment. More participants with normal sensory acuity passed the MoCA compared to those with sensory loss, even after modifying scores to adjust for sensory factors. The results suggest that cognitive abilities may be underestimated if sensory problems are not considered and that people with sensory loss are at greater risk of cognitive decline.

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Multiple contributors to neurocognitive impairment in individuals with sickle cell disease have been identified. Research indicates that a history of cerebrovascular accidents, such as silent infarcts and strokes are associated with greater cognitive decline among children with sickle cell disease. Additionally, disease effects such as hemoglobin and hematocrit levels significantly effect cognitive performance among this population and should be taken into consideration when examining neurocognitive impairment. Further, previous studies show a significant relationship between child behavior problems, family functioning, and cognitive performance in children with sickle cell, marking those as important targets for intervention among this population. While cognitive decline with increased age is not typically examined in healthy child populations, some research indicates the presence of age effects in those with SCD. A majority of the literature addresses cognitive impairment from a broad perspective, while a limited number of studies have begun to address effects among specific cognitive domains. Using archival data from the National Institutes of Health's Cooperative Study of Sickle Cell Disease, results revealed that disease severity was negatively correlated with some aspects of cognitive functioning, including visual-spatial domains. Additionally, some measures of cognitive performance were inversely correlated with age. Consistent with hypothesized outcomes, family functioning was strongly associated with measures of cognitive functioning. Implications are discussed.

The thesis Dynamic Loewenstein occupational therapy cognitive assessment in individuals after obtaining brain injury in working age deals with a comparison of the level of the brain injured and non-brain injured people's cognitive functions with the aid of the Loewenstein Occupational Therapy Cognitive Assessment battery (DLOTCA). The theoretical part is focused on an issue of the acquired brain injury, a description of cognitive areas and as well their pathology due to this injury. The aim of the practical part is to test the cognitive functions with the aid of the Loewenstein Occupational Therapy Cognitive Assessment. The survey's main object is the applicability of the working version of the Loewenstein Occupational Therapy Cognitive Assessment battery (DLOTCA), its translated version. The testing was carried out on seventy probands devided into three groups. Healthy people (n=50), cerebrovascular accident patients (n=10) and traumatic brain injury patients (n=10). Key words: obtained brain injury Dynamic Loewenstein occupational therapy cognitive assessment cognitive function working age occupational therapy cognitive assessment

The thesis Dynamic Loewenstein occupational therapy cognitive assessment in individuals after obtaining brain injury in working age deals with a comparison of the level of the brain injured and non-brain injured people's cognitive functions with the aid of the Loewenstein Occupational Therapy Cognitive Assessment battery (DLOTCA). The theoretical part is focused on an issue of the acquired brain injury, a description of cognitive areas and as well their pathology due to this injury. The aim of the practical part is to test the cognitive functions with the aid of the Loewenstein Occupational Therapy Cognitive Assessment. The survey's main object is the applicability of the working version of the Loewenstein Occupational Therapy Cognitive Assessment battery (DLOTCA), its translated version. The testing was carried out on seventy probands devided into three groups. Healthy people (n=50), cerebrovascular accident patients (n=10) and traumatic brain injury patients (n=10). Test results confirm all the stated hypothesis because it did not meet the prerequisites of the total evaluation. We assumed that a person healthy population will reach 100% success rate testing, which some individuals reached. In the assessment of persons with stroke by 6 out of 10 tested achieved a lower evaluation scores in most...

The purpose of this study was twofold: to determine the construct validities of comparable AD/HD instruments that were developed according to our current, DSM-IV classification system for AD/HD; and to identify potential +neurocognitive and socioemotional markers for AD/HD. The sample consisted of 145 children ages 8 to 11 years of age who were diagnosed with Attention Deficit Hyperactivity Disorder (AD/HD), or Central Auditory Processing Disorder (CAPD). Children were administered a battery of neurocognitive tests and completed a self-report measure of personality. Parents completed several, AD/HD instruments pertaining to their children. The AD/HD instruments used in this study were the Attention Deficit Disorder Evaluation Scale-Home Version (ADDES), Attention Deficit Hyperactivity Disorder Test (ADHDT), and the Attention Problems and Hyperactivity scales from the BASC-Monitor (BASC-M). Of interest was how each AD/HD instrument compared to the DSM-IV, particularly in terms of the cross-consistency of AD/HD subtype classifications. The findings showed that the AD/HD instruments classified participants differently from the initial, DSM-IV entry diagnosis. Rates of agreement were better for some of the AD/HD instruments than for others yet there was little overall consistency. The neurocognitive measures used in the study were the Cognitive Assessment System-Basic Battery scales. The socioemotional measures used in the study were two parent-report scales from the BASC-M (Internalizing Problems and Adaptive Skills), and the child report scales from the BASC-Self Report of Personality. Results showed that the neurocognitive measures were relatively insensitive to AD/HD symptomatology while a nearly opposite trend was observed on the socioemotional measures. For the most part, participants classified as the ADHD-Combined Type (ADHD-CT), (regardless of which AD/HD instrument was used) had the most significant impairment in areas of social functioning and emotional symptoms across parent and self-reports.