Hostname: page-component-76fb5796d-qxdb6 Total loading time: 0 Render date: 2024-04-25T07:27:00.875Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of the supervisory system in elderly subjects with and without disinhibition

Published online by Cambridge University Press:  16 April 2020

E Gokalsing ,
P.H. Robert ,
V Lafont ,
I Medecin ,
C Baudu ,
P Boyer ,
D Pringuey  and
G Darcourt
E Gokalsing
Affiliation:
Memory Center, Department of Psychiatry, University of Nice Sophia Antipolis, Nice, France
P.H. Robert*
Affiliation:
Memory Center, Department of Psychiatry, University of Nice Sophia Antipolis, Nice, France
V Lafont
Affiliation:
Memory Center, Department of Psychiatry, University of Nice Sophia Antipolis, Nice, France
I Medecin
Affiliation:
Memory Center, Department of Psychiatry, University of Nice Sophia Antipolis, Nice, France
C Baudu
Affiliation:
Memory Center, Department of Psychiatry, University of Nice Sophia Antipolis, Nice, France
P Boyer
Affiliation:
Memory Center, Department of Psychiatry, University of Nice Sophia Antipolis, Nice, France
D Pringuey
Affiliation:
Memory Center, Department of Psychiatry, University of Nice Sophia Antipolis, Nice, France
G Darcourt
Affiliation:
Memory Center, Department of Psychiatry, University of Nice Sophia Antipolis, Nice, France
*
*Correspondence and reprints: Pr P.H. Robert, Memory Center, Hôpital Pasteur, Pavillon J, 30 av. de la voie romaine, 06002 Nice, France. Email address: philippe.robert15@wanadoo.fr (P.H Robert)
Get access

Extract

Disinhibition and irritability, defined as loss of behavioral and emotional control, are frequent in the elderly. The working hypothesis for this study was that these disorders are associated with a cognitive alteration of control processes that manifests as non-routine behavior because of the dysfunction of a general executive component known as the supervisory attentional system (SAS).

Methods

A total of 28 elderly subjects with mild cognitive impairment were recruited and divided into two groups using the Neuropsychiatric Inventory. Fourteen subjects were allocated to the disinhibited group and 14 subjects matched for age, sex and educational level formed a disinhibition-free control group. The neuropsychological battery included the following tests: Mini Mental Score Evaluation, Boston Naming test, Token test, Trail Making and Verbal Fluency. Two tasks were specifically designed to stress the SAS: 1) A specific verbal sentence arrangement task in which subjects had to use sequential reasoning with verbal material. Each test sequence consisted of a series of words shown in jumbled order. The construction of some sequences had to be done by using familiar routine associations (valid conditions). In contrast, other sequences required the overriding selection of familiar routine associations, which were inappropriate within the general context of the task (invalid conditions). 2) Using the Continuous Performance Test, four aspects were evaluated: sustained, selective, preparation and suppressive attention.

Results

The only group differences in neuropsychological test results were the following: 1) the sentence arrangement task. In comparison with the control group, the disinhibited group was impaired in invalid conditions and the calculated difference between the number of correct responses in invalid conditions minus that in valid conditions was significantly higher; and 2) the CPT. Disinhibited subjects had a significantly lower number of hits, exclusively in the ‘suppressive attention’ paradigm.

These results suggest that subjects with disinhibition have impaired supervisory system function.

Keywords

behaviorcognitiondisinhibitionelderlyfrontalsupervision
Type
Original article
Information
European Psychiatry , Volume 15 , Issue 7 , November 2000 , pp. 407 - 415
Copyright
Copyright © 2001 Éditions scientifiques et médicales Elsevier SAS. All rights reserved

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexander, G.E.Crutcher, M.D.Functional architecture of basal ganglia circuits: neural substrates of parallel processing Trends Neurosci 1990; 13: 266–271CrossRefGoogle ScholarPubMed
Alexander, G.E.Crutcher, M.D.Delong, M.R.Basal ganglia-thalamocortical circuits: neural substrates of parallel processing Prog Brain Res 1990; 85: 119–146CrossRefGoogle Scholar
Alexopoulos, G.S.Abrams, R.C.Young, R.C.Shamoian, C.A.Cornell scale for depression in dementia Biol Psychiatry 1988; 23: 271–284CrossRefGoogle ScholarPubMed
Aubin, VJouvent, RWidlöcher, DDarcourt, GModélisation hypothétique du déficit sérotoninergique chez le sujet âgé L'Encéphale 1993; 19: 37–46Google Scholar
Baddeley, A.D.Hitch, GWorking memoryBower, G.A.The psychology of learning and motivation 1974 Academic Press New York47–89Google Scholar
Baddeley, A.D.Wilson, B.A.Frontal amnesia and the dysexecutive syndrome Brain Cogn 1988; 7: 212–230CrossRefGoogle ScholarPubMed
Baddeley, A.D.Della Sala, SPapagno, CSpinnler, HDual-task performance in dysexecutive and nondysexecutive patients with a frontal lesion Neuropsychology 1997; 11: 187–194CrossRefGoogle ScholarPubMed
Baddeley, A.D.The central executive: a concept and some misconceptions J Int Neuropsychol Soc 1998; 4: 523–526CrossRefGoogle ScholarPubMed
Barratt, E.S.Stanford, M.S.Kent, T.A.Felthous, ANeuropsychological and cognitive psychophysiological substrates of impulsive aggression Biol Psychiatry 1997; 41: 1045–1061CrossRefGoogle ScholarPubMed
Benton, A.L.Differential behavioral effects in frontal lobe disease Neuropsychologia 1968; 6: 53–60CrossRefGoogle Scholar
Benton, A.L.Focal brain damage and the concept of localization of functionLoeb, CStudies in cerebrovascular disease 1981 Masson Italia Editore MilanGoogle Scholar
Burgess, P.W.Shallice, TFractionnement du syndrome frontal Rev Neuropsychol 1994; 4: 345–370Google Scholar
Burns, AFolstein, SBrandt, JFolstein, MClinical assessment of irritability, aggression and apathy in Huntington and Alzheimer disease J Nerv Ment Dis 1990; 178: 20–26CrossRefGoogle ScholarPubMed
Burns, AJacoby, RLevy, RPsychiatric phenomena in Alzheimer disease. IV: disorders of behaviour Br J Psychiatry 1990; 157: 86–94CrossRefGoogle ScholarPubMed
Caine, E.D.Diagnostic classification of neuropsychiatric signs and symptoms in patients with dementia Int Psychogeriatr 8 Suppl 3 1996 273–279CrossRefGoogle ScholarPubMed
Cardebat, DDoyon, BPuel, MGoulet, PJoanette, YEvocation léxicale formelle et sémantique chez des sujets normaux : Performances et dynamiques de production en fonction du sexe, de l'âge et du niveau d'étude Acta Neurol Bel 1990; 90: 207–217Google Scholar
Corcoran, RUpton, DA role for the hippocampus in card sorting? Cortex 1993; 23: 787–790Google Scholar
Cummings, J.L.Mega, MGray, KRosenberg-Thompson, SCarusi, D.A.Gornbein, TThe Neuro-Psychiatric Inventory: comprehensive assessment of psychopathology in dementia Neurology 1994; 44: 2308–2314CrossRefGoogle Scholar
Cummings, J.L.The Neuropsychiatric Inventory: assessing psychopathology in dementia patients Neurolology 48 Suppl 6 1997 10–16CrossRefGoogle ScholarPubMed
De Renzi, EVignolo, L.A.The token test: a sensitive test to detect disturbances in aphasics Brain 1962; 85: 665–678CrossRefGoogle ScholarPubMed
Della Malva, CStuss, D.T.D’Alton, JWillmer, JCapture errors and sequencing after frontal brain lesions Neuropsychologia 1993; 31: 363–372CrossRefGoogle ScholarPubMed
Devanand, D.P.Miller, LRichards, MMarder, KBell, KMayeux, R et al. The Columbia University Scale for Psychopathology in Alzheimer’s disease Arch Neurol 1992; 49: 371–376CrossRefGoogle ScholarPubMed
Devinsky, OMorrell, M.J.Vogt, B.A.Contributions of anterior cingulate cortex to behaviour Brain 1995; 118: 279–306CrossRefGoogle ScholarPubMed
Finkel, S.I.Costa de Silva, JCohen, GMiller, SSartorius, NBehavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment Inte Psychogeriatr 8 Suppl 3 1996 497–499CrossRefGoogle ScholarPubMed
Folstein, M.F.Folstein, S.E.McHugh, P.R.Mini mental state: a practical method for grading the cognitive state of patients for the clinician J Psychiatr Res 1975; 12: 189–198CrossRefGoogle ScholarPubMed
Gray, J.A.Dopamine release in the nucleus accumbens: the perspective from aberrations of consciousness in schizophrenia Neuropsychologia 1995; 33: 1143–1153CrossRefGoogle Scholar
Hécaen, HRuel, JSièges lésionnels intra-frontaux et déficit au test de fluence verbale Rev Neurol (Paris) 1981; 137: 277–284Google Scholar
Kaplan, E.F.Goodglass, HWeintraub, SThe Boston Naming Test 1987 publisher BostonGoogle Scholar
Kaplan, E.F.Fein, DMorris, RDelis, DWAIS-R as a neuropsychological instrument 1991 The Psychological Corporation San-AntonioGoogle Scholar
Lafont, VMedecin, IRobert, P.H.Beaulieu, F.-E.Kazes, MDanion, J.M. et al. Initiation and supervisory processes in schizophrenia and depression Schizophr Res 1998; 34: 49–57CrossRefGoogle ScholarPubMed
Lecrubier, YBraconnier, ASaid, SPayan, CThe Impulsivity Rating Scale (IRS): preliminary results Eur Psychiatry 1995; 10: 331–338CrossRefGoogle ScholarPubMed
Levin, H.S.High, W.M.Goethe, K.E.Sisson, R.A.Overall, T.E.Rhoades, H.M. et al. The Neurobehavior Rating Scale: assessment of the sequelae of head injury by the clinician J Neurol Neurosurg Psychiatry 1987; 50: 183–193CrossRefGoogle Scholar
Lezack, M.D.Neuropsychological assessment 2nd 1983 Oxford University Press New YorkGoogle Scholar
Luria, A.R.Higher cortical functions in man. English translation of first edition by Haigh B 1966 Basic Books & Plenum Press New YorkGoogle Scholar
Malloy, PBihrle, ADuffy, JCimino, CThe orbitomedial frontal syndrome Arch Clin Neuropsychol 1993; 8: 185–201CrossRefGoogle ScholarPubMed
McFie, JThompson, J.A.Picture arrangement: a measure of frontal lobe function Br J Psychiatry 1972; 121: 547–552CrossRefGoogle ScholarPubMed
Mckhann, GDrachman, DFolstein, MKatzman, RPrice, DStadlan, E.M. et al. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s disease Neurology 1984; 34: 939–944CrossRefGoogle ScholarPubMed
Mega, MCummings, J.L.Frontal-subcortical circuits and neuropsychiatric disorders J Neuropsychiatry Clin Neurosci 1994; 6: 358–370Google ScholarPubMed
Mega, M.S.Cummings, J.L.Fiorello, TGornbein, JThe spectrum of behavioral changes in Alzheimer’s disease Neurology 1996; 46: 130–135CrossRefGoogle ScholarPubMed
Miller, L.A.Milner, BCognitive risk taking after frontal or temporal lobectomy – II. The synthesis of phonemic an semantic information Neuropsychologia 1985; 23: 371–379CrossRefGoogle ScholarPubMed
Miller, L.A.Impulsivity, risk taking, and the ability to synthesise fragmented information after frontal lobectomy Neuropsychologia 1992; 30: 69–79CrossRefGoogle Scholar
Montgomery, S.A.Äsberg, MA new depression scale designed to be sensitive to change Br J Psychiatry 1979; 134: 382–389CrossRefGoogle ScholarPubMed
Nathaniel-James, D.A.Frith, C.D.Confabulation in schizophrenia: evidence of a new form Psychol M 1996; 26: 391–399CrossRefGoogle ScholarPubMed
Norman, D.A.Shallice, TAttention to action: willed and automatic control of behaviourDavidson, R.J.Schwartz, G.E.Shapiro, DConsciousness and self-regulation Vol. 4 1986 Plenum Press New York1–18Google Scholar
Orgogozo, J.M.Auriacombe, SSyndrome démentielTechniques. Encyclopédie Médico-Chirurgicale, neurologie, 17-056-A-20 1995 Elsevier Science Paris5–50Google Scholar
Overall, JGornham, D.R.The Brief Psychiatric Rating Scale Psychol Rep 1962; 10: 799–812CrossRefGoogle Scholar
Owen, A.M.Downes, J.J.Sahakian, B.J.Polkey, C.E.Robbins, T.W.Planning and spatial working memory following frontal lobe lesions in man Neuropsychologia 1990; 28: 1021–1034CrossRefGoogle ScholarPubMed
Perret, EThe left frontal lobe of man and the suppression of habitual responses in verbal categorical behaviour Neuropsychologia 1974; 12: 323–330CrossRefGoogle ScholarPubMed
Petrides, MMilner, BDeficits on subject-ordered tasks after frontal and temporal lobe lesions in man Neuropsychologia 1982; 29: 249–262CrossRefGoogle Scholar
Reisberg, GBorenstein, JSalob, S.P.Ferris, S.H.Franssen, EGeorgotas, ABehavioral symptoms in Alzheimer’s disease: phenomenology and treatment J Clin Psychiatry 48 Suppl 5 1987 9–15Google ScholarPubMed
Reitan, R.M.Validity of the Trail Making Test as an indication of organic brain damage Percept Mot Skills 1958; 8: 271–276CrossRefGoogle Scholar
Robert, P.H.Migneco, VChaix, IBerthet, LKazes, MDanion, J.M. et al. Use of a sequencing task designed to stress the supervisory system in schizophrenic subjects Psychol M 1997; 27: 1287–1294CrossRefGoogle ScholarPubMed
Rosvold, H.E.Mirsky, A.F.Sarason, IBransome, E.D.J.Beck, L.H.A Continuous Performance Test of brain damage J Consult Psychol 1956; 20: 343–350CrossRefGoogle Scholar
Roy-Byrne, PScheele, LBrinkley, JWard, NWiatrak, CRusso, J et al. Adult attention-deficit hyperactivity disorder: assesment guidelines based on clinical presentation to a specialty clinic Compr Psychiatry 1997; 38: 133–140CrossRefGoogle Scholar
Shallice, TBurgess, P.W.Deficits in strategy applications following frontal lobe damage in man Brain 1991; 114: 727–741CrossRefGoogle Scholar
Shallice, TBurgess, P.W.Higher-order cognitive impairments and frontal lobe lesions in manLevin, H.S.Eisenberg, H.M.Benton, AFrontal lobe function and dysfunction 1991 Oxford University Press New York125–138Google Scholar
Shallice, TBurgess, P.W.The domain of supervisory processes and temporal organization of behaviour Philos Trans R Soc Lond 1996; 351: 1405–1411Google ScholarPubMed
Solanto, M.V.Conners, C.K.A dose response and time-action analysis of autonomic and behavior effects of methylphenidate in attention deficit disorder with hyperactive children Psychophysiology 1982; 19: 658–667CrossRefGoogle Scholar
Stroop, J.R.Studies of interference in serial verbal reactions J Exp Psychol 1935; 18: 643–662CrossRefGoogle Scholar
Stuss, D.T.Benson, D.F.The frontal lobes 1986 Raven New YorkGoogle Scholar
Stuss, D.T.Shallice, TAlexander, M.P.Picton, T.W.A multidisciplinary approach to anterior attentional functions Annals N Y Acad Sci 1995; 769: 191–211CrossRefGoogle ScholarPubMed
Stuss, D.T.Alexander, M.P.Benson, D.F.Frontal lobe functionsTrimble, M.R.Cummings, J.L.Contemporary behavioral neurology 1997 Butterworth-Heinemann Boston169–187Google Scholar
Sultzer, D.L.Mahler, M.E.Cummings, J.L.Van Gorp, W.G.Hinkin, C.H.Brown, CCortical abnormalities associated with subcortical lesions in vascular dementia: clinical and PET findings Arch Neurol 1995; 52: 773–780CrossRefGoogle Scholar
Sultzer, D.L.Mahler, M.E.Mandelkern, M.A.Cummings, J.L.Van Gorp, W.G.The relationship between psychiatric symptoms and regional cortical metabolism in Alzheimer’s disease J Neuropsychiatry Clinical Neurosci 1995; 7: 476–484Google ScholarPubMed
Troyer, A.K.Moscovitch, MWinocur, GClustering and switching as two components of verbal fluency: evidence from younger and older healthy adults Neuropsychology 1997; 11: 138–146CrossRefGoogle ScholarPubMed
Webster, JGrossberg, G.T.Disinhibition, apathy, indifference, fatigability, complaining and negativism Int Psychogeriatr 8 Suppl 3 1996 403–408CrossRefGoogle ScholarPubMed
Wechsler, DWechsler Adult Intelligence Scale–revised test manual 1981 Psychological Corporation New YorkGoogle Scholar
Wheeler, M.A.Stuss, D.T.Tulving, EToward a theory of episodic memory: the frontal lobes and autonoetic consciousness Psychol Bull 1997; 121: 331–354CrossRefGoogle Scholar
World Health Organization The ICD-10 classification of mental and behavioral disorders: clinical descriptors and diagnostic guidelines 1992 WHO GenevaGoogle Scholar
Zaudig, MBehavioral disturbances of dementia in DSM-IV and ICD-10: fact or fiction? Int Psychogeriatr 8 Suppl 3 1996 285–287CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.