Yes / While there is a growing literature on the experiences of disabled workers, this article presents an account of a work experience not frequently documented: being employed while living with dementia. It does this through the account of Elizabeth Draper, an NHS Hospital Trust manager, who received a diagnosis of dementia while employed. The article offers new ways of conceptualizing the struggles of disabled workers to continue with their project of self-becoming through work. It shows how work practices can enact violence through ‘non-recognition’ and how workers can subvert this violence to create opportunities for future development.

Introduction: Idiopathic Parkinson's disease (PD) is a chronic and progressive neurodegenerative disorder that is characterised by motor symptoms. However, there is increasing awareness that a range of neuropsychiatric and cognitive problems also accompanys PD. The objective of this thesis was to examine the profile of neuropsychiatric and cognitive problems for patients with PD without dementia. Parkinson's disease patients who could be identified at the time of this study were invited to participate. Each patient was individually matched to a healthy control in terms of age, premorbid intelligence, and years of education. Results: Neuropsychiatric symptoms were common for this patient group, over 40% self reported symptoms consistent with depression, 40% with physical fatigue, 38% with mental fatigue, 38% with apathy and 32% with sleep problems. More than 77% of patients with PD reported symptoms associated with at least one problem and over 46% with 3 or more problems. Increased symptoms consistent with depression and anxiety and the presence of hallucinations also predicted poorer quality of life after controlling for motor symptoms. However, the of level agreement between patient report and that of a person who know them well was low: 40.9% for apathy, 28% for hallucinations, 39% for depression, 25% for sleep problems and only 7.7% agreement for the presence of anxiety. To obtain an accurate profile of cognitive impairments patients were assessed on measures of higher order language ability and a broad range of commonly used cognitive tests. Overall, PD patients were impaired on aspects of higher-order language. However, results indicated that these deficits were not a primary effect of PD, but could be explained in terms of deficits in speed of information processing associated with the disease. Compared to healthy controls, PD patients also showed deficits on measures of executive function, working memory, problem solving, and visuospatial skills. However, they were unimpaired on measures of planning, attention and memory/learning. Deficits in problem solving were only evident for tasks with a high visuospatial content and were no longer significant when visuospatial skills were controlled for. Further investigation indicated that planning in PD patients was not impaired in general and was dependent on the sensitivity of tests used. To further examine cognitive deficits, patients were divided into groups according to their cognitive performance. Three sub-groups of patients were identified that formed a continuum of cognitive impairment from none/mild to severe. Compared to controls, one subgroup showed no or minimal impairment (PD-NCI), a second group showed a more variable pattern of severe and mild impairments (PD-UCI), and a third group had evidence of severe impairment across most of the cognitive domains tested. This latter group was labelled PD-Mild Cognitive Impairment (PD-MCI). The PD-UCI and PD-MCI groups were also significantly different from their controls with respect to their ability to carry out functional activities of everyday living. The PD-MCI group had evidence of global cognitive decline, possibly reflecting a stage of pre-clinical dementia. The severity of cognitive deficits was not associated with other clinical and demographic characteristics such as motor impairments, age or disease duration. These results were confirmed when patients were retested one year later. Conclusions: Comorbid neuropsychiatric and cognitive problems are common for patients with PD prior to any overt signs of dementia. However, PD patients are heterogeneous with regard to their presentation and different subgroups of patients are identifiable based on cognitive performance. This information has both theoretical and clinical relevance.

Le diagnostic de la maladie d'« Alzheimer » (MA) repose essentiellement sur des tests neuropsychologiques, démontrant d'importants déficits mnésiques en lien avec l'atrophie de l'hippocampe. Parallèlement à cela, l'existence d'une atteinte précoce de l'amygdale a très récemment été proposée dans une série d'études, suggérant que cette structure pourrait être un marqueur neuro-anatomique de l'entrée dans la maladie. Les études ayant évalué les répercussions émotionnelles de ces atteintes amygdaliennes n'ont néanmoins pas permis d'aboutir à l'identification d'un profil convergent de déficits. L'objectif de cette thèse a donc été de démontrer l'existence d'une atteinte de l'amygdale à un stade précoce de la MA entrainant des modifications des traitements émotionnels. Dans une première étude en neuroimagerie structurelle, nous avons montré des arguments robustes quant à l'existence d'atteintes anatomiques de l'amygdale chez des patients légèrement atteints par la maladie. L'amplitude de cette atrophie s'est avérée être un indicateur particulièrement sensible du niveau général d'atteintes cognitives mesurées chez nos patients. Dans les études suivantes, nous nous sommes intéressés aux répercussions de cette atteinte sur des activités cognitives sous-tendues plus directement par le fonctionnement de cette structure : les traitements émotionnels. Par l'élaboration d'une méta-analyse, nous avons pu identifier un déficit précoce de la reconnaissance des émotions. Nous avons de plus démontré que les troubles cognitifs des patients expliquaient en partie le déficit émotionnel, sans toutefois l'expliquer dans sa totalité. Enfin, une série d'études comportementales et en neuroimagerie fonctionnelle, a permis de confirmer que les atteintes anatomiques s'accompagnaient bien d'un dysfonctionnement de l'amygdale entrainant des déficits émotionnels, en particulier dans les mécanismes à l'origine de l'extraction spontanée de la saillance émotionnelle. L'ensemble de nos données convergent vers l'idée que l'atteinte amygdalienne et les altérations des mécanismes émotionnels seraient une piste prometteuse afin de préciser le diagnostic actuel de la MA. / The diagnosis of “Alzheimer's” disease (AD) relies on neuropsychological tests demonstrating massive memory decline, which is mainly associated with hippocampus lesions. In parallel, several neuroimaging studies have suggested that amygdala volume loss could be a neuroanatomical marker of AD. However, previous works dealing with behavioural indices of amygdala activity in AD have been unable to provide a converging profile of emotional impairments. The goal of this work was to corroborate data provided from various methods to demonstrate that amygdala lesions in relation to emotional disorders could be an interesting track to refine the current diagnosis of AD. In a first structural neuroimaging study, we have demonstrated that the amygdala undergoes massive atrophy in the early stage of the disease, and that volume loss predicts memory decline. In the following studies, we have shown that these lesions lead to impairments in a various set of emotional tests. Based on a meta-analytic approach, we demonstrated that emotional decoding abilities are impaired in AD, beginning in the early stage, and partly explained by the cognitive deficits characterizing the AD population. In a last set of studies we demonstrated that these emotional decoding difficulties rely on specific amygdala dysfunctions, by showing that the mechanisms behind the spontaneous extraction of emotional salience are impaired in AD. All our data converge on the idea that the amygdala damage and alteration of emotional mechanisms from the early phase of AD are a promising approach to clarify the current diagnosis of AD.

No description available.

Les tumeurs de la fosse postérieure (PFT) représentent les deux tiers des tumeurs cérébrales pédiatriques. Les PFT malignes les plus fréquentes sont le médulloblastome (40%), suivie de l'épendymome (10%). La chirurgie, la radiothérapie et/ou la chimiothérapie sont les approches thérapeutiques utilisées à l’heure actuelle. En raison de l'amélioration des traitements, la survie a augmenté de façon significative. Cependant, ces enfants souffrent de déficiences cognitives variées en partie attribuées à la radiothérapie et ce d’autant plus qu’ils sont jeunes. Atténuer les séquelles neurocognitives est devenu ces dernières années un des enjeux majeurs de l'oncologie pédiatrique. Dans cette optique, ce travail examine chez des enfants traités pour une PFT, les relations entre doses de radiothérapie reçues et performances neuropsychologiques en fonction de l’âge, au moyen d’une approche associant la neuroimagerie et la neuropsychologie. La contribution expérimentale s’articule autour de deux principaux axes. Le 1er axe utilise une approche exploratoire pour rendre compte des relations entre l’irradiation des régions cérébrales et le déclin cognitif chez les enfants traités pour une PFT. L’analyse des données met en relation des patterns spatiaux de répartition des doses dans le cerveau avec la variation des scores neuropsychologiques dans le temps (Mémoire de travail, vitesse de traitement, QI). Nos principaux résultats suggèrent une association entre la diminution des capacités en mémoire de travail et l’augmentation des doses (Dose uniforme équivalente, EUD) délivrées aux régions orbitofrontales ; alors qu’un ralentissement de la vitesse de traitement semble être lié à une dose élevée dans les lobes temporaux et la fosse postérieure. Le 2nd axe utilise une approche a priori pour déterminer l’impact de la maladie et des traitements sur le développement de la mémoire épisodique (ME) et des hippocampes, chez de jeunes enfants (2-13 ans). Cette partie se structure autour d’une part de l’analyse des performances des patients lors d’une tâche expérimentale mesurant la ME et d’autre part, d’une analyse longitudinale des volumes hippocampiques de ces enfants pendant le traitement. Nous avons a mis en évidence chez les enfants avec PFT une altération de la ME dépendant de l’âge : Chez les patients plus jeunes (<7 ans), l'altération était globale tandis que chez les plus âgés, elle ne concernait que la reconnaissance à long terme des détails temporels (c'est-à-dire «quand»). L’analyse des données volumiques hippocampiques n’a pas pu être achevée dans le temps de cette thèse, compte tenu de plusieurs difficultés méthodologiques liées notamment au recalage longitudinal des cerveaux en croissance. Ce travail apporte des connaissances nouvelles sur le rôle de certains facteurs dans l’émergence de difficultés cognitives spécifiques. La prévention des séquelles à long terme de ces enfants reste un défi pour les années à venir. / Pediatric posterior fossa tumors (PFT) account for two-thirds of all pediatric brain tumors. The most common malignant PFT is medulloblastoma (40%), followed by ependymoma (10%). Surgery, radiotherapy and/or chemotherapy are the current therapeutic approaches. As a result of the progress of treatment, event-free survival has significantly improved. Unfortunately, these children suffer from many cognitive impairments partly attributed to radiotherapy, especially in young children. Alleviating neurocognitive impairments has become one of the major challenges of pediatric oncology. Using an approach combining neuroimaging and neuropsychology, this work examines the relationship between treatments and neuropsychological performances as a function of age in children treated for PFT. The experimental contribution is based on two main axes. The first axis uses an exploratory approach to investigate the relationship between the decline of intellectual functioning and radiation dose distribution. For this purpose, we analyze, with a whole brain analysis, the relation between regional biological dose and changes over time of different cognitive scores (IQ, processing speed and working memory). Our results suggest a positive association between working memory decline and high dose (Equivalent Uniform Dose, EUD) delivered to the orbitofrontal regions, whereas decline of processing speed seems more related to EUD in the temporal lobes and posterior fossa. The 2nd axis uses a hypothesis-driven approach to determine the susceptibility of episodic memory (EM) impairment and hippocampal alteration in young child PFT patients (2-13yo). This part is structured around two aims: First, the assessment of PFT EM performances, thanks to an EM task, in comparison to Controls; second, the exploration of longitudinal patterns of hippocampal volume as a potential neural substrate underlying EM performance. The main results support the evidence of EM impairment in the PFT condition, which varied according to age: in the younger patients (<7yo) impairment was global while in the older it involved only the long term recognition of temporal details (i.e. ‘When’). However, at this stage of the work, several methodological difficulties mainly related to the registration parameters of the segmentation algorithm prevent us from achieving hippocampal volume analysis. This work brings new knowledge about the role of some risk factors on specific cognitive difficulties. Preventing long-term impairments of these children remains a challenge for years to come.

Background: In recent years it has become recognized that schizophrenia is associated with cognitive impairment, which affects particularly executive function and memory. Although cognitive impairment implies brain damage or dysfunction, little is known about the relationship of cognitive impairment in schizophrenia to the structural and functional brain abnormalities that characterize the disorder. Aims and hypothesis: This study aimed to identify structural and/or functional brain abnormalities associated with cognitive impairment in schizophrenia. According to the literature reviewed, the general hypothesis is that the cognitive deficits of schizophrenic patients are reflected in both structural and functional brain changes. Accordingly, we expect that patients with cognitive impairment will have more GM reductions and more dysfunctional patterns of brain activity than patents without such deficits. Method. structural MRI and voxel-based morphometry was carried out in 26 cognitively impaired and 23 cognitively preserved schizophrenia patients, plus 39 matched controls. Nineteen cognitively impaired patients, 18 cognitively preserved patients and 34 controls also underwent fMRI during performance of a working memory task. Some subjects, partly corresponding to the ones participating in the neuroimaging study, were also administered a battery of tests of different cognitive functions. Altogether, 25 participants with schizophrenia and relatively preserved cognitive function, 29 with impaired functions and 22 healthy participants were included in this part of the study. Results: The participants with cognitive impairment in executive functioning and memory also perform worse on visuospatial and language tasks when compared to other patients intact in memory and executive function and controls. These differences are independent of estimated premorbid IQ. No differences were found between the cognitively intact and cognitively impaired groups in lateral ventricular volume or whole brain volume. Voxel-based morphometry also failed to reveal clusters of significant difference in either GM or WM volume between the two patient groups. However, during performance of the n-back task, the cases with schizophrenia and impaired cognitition showed hypoactivation compared to the cognitively intact patients in DLPFC among other brain regions. Conclusions: This study provides evidence that structural brain abnormality in schizophrenia is a function of having the disorder, not the cognitive impairment that accompanies it. In contrast, a substantial part of the task-related functional imaging abnormality appears to reflect cognitive impairment. / MARCO: Los déficits cognitivos son una característica conocida de la esquizofrenia. Sin embargo, poco se sabe sobre su relación con las anormalidades cerebrales tanto estructurales como funcionales que caracterizan dicha enfermedad. OBJETIVOS: Identificar las alteraciones estructurales y/o funcionales asociadas al déficit cognitivo en la esquizofrenia. MÉTODO: Se adquirió imágenes de resonancia magnética funcional (RMf) y morfometría basada en el vóxel (VBM) en 26 participantes que tenían alteraciones cognitivas y 23 que presentaban una cognición relativamente preservada, todos con esquizofrenia, así como en 39 controles apareados. Diecinueve de quienes presentaban déficits cognitivos y 18 de los preservados cognitivamente y 24 controles también ejecutaron una tarea n-back de memoria de trabajo durante la adquisición de imágenes de RMf. RESULTADOS: No se encontró diferencias entre los participantes con cognición preservada y quienes presentaban déficits cognitivos en el volumen de los ventrículos laterales ni tampoco en el volumen cerebral total. La VBM tampoco mostró clústers con diferencias significativas entre ambos grupos en el volumen de sustancia blanca y gris. Sin embargo, durante la realización de la tarea n-back de memoria de trabajo, los participantes con alteración cognitiva presentaron hipoactivación en la corteza prefrontal dorsolateral, entre otras regiones, en relación a quienes mostraban una cognición preservada. CONCLUSIONES: No se encontró evidencia de que los déficits cognitivos de la esquizofrenia sean una función de anormalidades cerebrales estructurales que acompañan a la enfermedad sino que se asociarían con un funcionamiento cerebral alterado.

Les troubles cognitifs constituent incontestablement une des caractéristiques les plus invalidantes de la schizophrénie et sont fortement corrélés aux perturbations de la vie quotidienne et de l’insertion socioprofessionnelle des patients. Différents programmes de remédiation cognitive ont vu le jour ces dernières années. S’ils semblent être le corollaire destroubles cognitifs, leurs bénéfices sur le statut fonctionnel des patients restent peu convaincants à ce jour. En cause : la non prise en compte de la double hétérogénéité des troubles cognitifs et des plaintes des patients. L’alternative proposée à ces études consiste à travailler selon la méthodologie des cas unique ou multiple en partant du pragmatisme des plaintes des patients, pour mettre en oeuvre des interventions centrées sur les activités spécifiques de la vie quotidienne mettant en jeu les aspects fonctionnels altérés. L’objectif de cette thèse a été d’étudier l’efficacité d’une telle démarche. Deux prises en charge individualisées et une prise en charge de groupe ont été élaborées. Une première étude visait à optimiser la réalisation des activités particulières de la vie professionnelle du sujet à travers l’accroissement de l’efficacité de deux sous-composantes de la Mémoire de Travail ; les deux autres études se sont focalisées sur les aspects exécutifs de la mémoire épisodique verbale et ont inclus une stratégie organisationnelle de l’encodage visant à promouvoir les opérations de compréhension et de structuration de l’information, dans le but d’optimiser la réalisation d’activités de la vie quotidienne (lectures, conversations, sorties culturelles, suivi de programmes TV). Les résultats témoignent de l’efficacité et de la spécificité de chacune de ces interventions. Un suivi à long terme a permis d’objectiver une stabilité dans le maintien des acquis et un transfert durable des différents apprentissages dans la vie professionnelle et quotidienne d’un des sujets. / Cognitive impairment is undeniably one of the most debilitating characteristics of schizophrenia, and is also highly correlated with everyday-life, social and professional integration difficulties found in patients. Many cognitive remediation programs have been created in the last few years. However, if they seem to be corollary of cognitive dysfunction, their effects on patients’ functional status seem less convincing. This is not surprising since the double heterogeneity found in cognitive impairments and patients’ complaints is not taken into account. Our alternative to these studies consists of focusing on single and multiple-case studies, and to design functionally-driven interventions specifically suited to everyday-life difficulties patients complain of. The aim of this thesis is therefore to evaluate the efficiency of this framework through individualized and group interventions. Our first study aimed at improving the patient’s ability to perform specific tasks at work via an increased efficiency of two Working Memory sub-components (mental load and management of interferences); the following two studies focused on executive aspects involved in verbal episodic memory. These two studies included an organizational strategy, which aimed at facilitating comprehension and structuration of information, in order to optimize their participation in every-day life activities (reading, conversations, cultural activities, watching TV shows or films). Our results show that these interventions are efficient and specific. Long-term assessments also suggest that the improvements are stable over time, an

No description available.

Introduction. The aim of this master’s thesis is to examine which factors affect how Swedish public libraries, financed by a grant from the Swedish Arts Council, work to improve their accessibility for people with cognitive disabilities. Method. We have used qualitative methods for our study. The methods are semi-structured interviews with representatives from six public libraries, participant observation of a lecture about cognitive accessibility by Begripsam AB and a review of the libraries’ applications for the grant. The theoretical approaches are Critical Disability Theory, Stigma Theory and Spoon Theory. Results. Our results show that the libraries use a solution-oriented approach to improve their accessibility. They have focused on improving the physical library, for example by making the lighting, sound environment, information, and signage more accessible. All libraries have collaborated with Begripsam. People with cognitive disabilities are a versatile group with different needs, which makes it difficult to follow the Swedish library law to be “accessible to all”. There are several laws and guidelines regarding cognitive accessibility, but they seem to be hard to find and interpret. Conclusion. Our study shows that the grant from the Swedish Arts Council has been necessary to make the libraries more accessible for people with cognitive disabilities. Begripsam has had a great impact on what the libraries have done to improve their cognitive accessibility. There seems to be a need to make the guidelines on accessibility for people with cognitive disabilities more accessible for library staff. The grant is temporary, but the process of making libraries more accessible never ends. The lack of adequate finances is an obstacle for the public libraries’ ability to be accessible for all, and they would benefit from a more permanent solution. This is a two-year master’s thesis in Library and Information Science.

Les épilepsies bénignes partielles idiopathiques de l'enfant sont associées à un pronostic favorable, car les crises sont rares et disparaissent à l'adolescence. La nature bénigne de ces syndromes est remise en question en raison de difficultés d'apprentissage et de déficits cognitifs subtils, fréquemment rapportés dans cette population. Nous étudions l’incidence des décharges épileptiques inter-critiques sur la cognition, et observons leurs influences sur l’organisation cérébrale et les fonctions cognitives. Nous proposons des épreuves informatisées, à des patients avec des pointes centro-temporales (EPCT) principalement localisées à l'un des deux hémisphères et occipitales de type Panayiotopoulos (SP), afin d'évaluer des compétences verbales, visuo-spatiales, visuo-attentionnelles, ainsi que trois processus d’imagerie mentale visuelle jamais étudiés dans ces syndromes. Les données comportementales renforcent l’idée d’une spécificité des perturbations selon la latéralisation hémisphérique des pointes inter-critiques et confirment leur incidence sur l’organisation de l’asymétrie hémisphérique fonctionnelle associée aux fonctions étudiées. Par ailleurs, nous montrons que le SP a une incidence particulièrement négative sur les processus d'imagerie mentale visuelle, compétences centrales pour la réussite scolaire de l’enfant et l’enrichissement de son imaginaire. Nos résultats sont en adéquation avec la remise en question actuelle de la nature bénigne de ces épilepsies sur le plan cognitif. Comparer les déficits et l’asymétrie hémisphérique fonctionnelle selon la localisation principale des pointes procure de nouveaux arguments pour un impact spécifique des manifestations inter-critiques, car seuls les mécanismes cognitifs sous-tendus par les régions concernées sont perturbés. Cela apporte des éléments d’explications sur les difficultés d'apprentissages signalés chez ces enfants, et incite à proposer des aménagements pédagogiques. / Benign idiopathic partial epilepsies of children are associated with a favorable prognosis because of rare seizure and usually recovery during adolescence. The benign nature of these syndromes is questioned because of learning difficulties and subtle cognitive deficits, frequently reported in this population. We study the incidence of the epileptic discharges on the cognition, and observe their influences on brain organization and cognitive functions. We propose computerized tests to patients with centrotemporal spikes (BECT) mainly localized in one of both hemispheres and occipital discharges, Panayiotopoulos syndrome (PS), to estimate verbal, visuo-spatial and visuo-attentional skills, as well as three visual imagery processes still never studied in these syndromes. Behavioural data strengthen the idea of a specific disturbances according to the hemispheric lateralization of the discharges and confirm their incidence on the organization of the functional hemispheric asymmetry associated with the studied functions. Furthermore, we show that PS has a particularly negative impact on the visual imagery process, important skills in the child's academic success and enrichment of his imagination. Our results are consistent with the current questioning of the benign nature of epilepsy on the cognitive level. Compare the deficits and the functional hemispheric asymmetry according to the main localization of discharges gets new arguments for a specific impact of the epileptiform activity, because only the cognitive mechanisms underlain by the concerned regions are disrupted. This provides evidence to explain the learning difficulties identified in these children, and encourages them to provide educational facilities.