Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-25T18:29:16.489Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluación del sistema supervisor en sujetos ancianos cony sin desinhibición

Published online by Cambridge University Press:  12 May 2020

E. Gokalsing ,
P. H. Robert ,
V. Lafont ,
I. Medecin ,
C. Baudu ,
P. Boyer ,
D. Pringuey  and
G. Darcourt
E. Gokalsing
Affiliation:
Centro para la Memoria, Departamento de Psiquiatria, Universidad de Nice Sophia Antipolis, Niza, Francia
P. H. Robert
Affiliation:
Centro para la Memoria, Departamento de Psiquiatria, Universidad de Nice Sophia Antipolis, Niza, Francia
V. Lafont
Affiliation:
Centro para la Memoria, Departamento de Psiquiatria, Universidad de Nice Sophia Antipolis, Niza, Francia
I. Medecin
Affiliation:
Centro para la Memoria, Departamento de Psiquiatria, Universidad de Nice Sophia Antipolis, Niza, Francia
C. Baudu
Affiliation:
Centro para la Memoria, Departamento de Psiquiatria, Universidad de Nice Sophia Antipolis, Niza, Francia
P. Boyer
Affiliation:
Centro para la Memoria, Departamento de Psiquiatria, Universidad de Nice Sophia Antipolis, Niza, Francia
D. Pringuey
Affiliation:
Centro para la Memoria, Departamento de Psiquiatria, Universidad de Nice Sophia Antipolis, Niza, Francia
G. Darcourt
Affiliation:
Centro para la Memoria, Departamento de Psiquiatria, Universidad de Nice Sophia Antipolis, Niza, Francia
Get access

Resumen

La desinhibición y la irritabilidad, definidas como la pérdida de control del comportamiento y la emotión, son frecuentes en los ancianos. La hipótesis de trabajo para este estudio era que estos trastornos se asocian con una alteratión cognitiva de los procesos de control que se manifiesta como un comportamiento no habitual a causa de la disfunción de un componente ejecutivo general conocido como Sistema Atentivo Supervisor (SAS). Métodos. Se seleccionó un total de 28 sujetos ancianos con deterioro cognitivo leve y se los dividió en dos grupos utilizando el Inventario Neuropsiquiátrico. Catorce sujetos se asignaron al grupo desinhibido y 14 sujetos emparejados en cuanto a la edad, el sexo y el nivel educativo formaron un grupo de control sin desinhibición. La batería neuropsicológica incluía las pruebas siguientes: Mini Examen del Estado Mental, el Test de Nombres de Boston, el Test de Fichas, el Test de Trazado y la prueba de fluidez verbal. Se diseñaron específicamente dos tareas para someter a un esfuerzo al SAS: 1) Una tarea verbal específica de ordenación de oraciones en la que los sujetos tenían que utilizar razona-miento secuencial con material verbal. Cada secuencia de prueba consístia en una serie de palabras que se mostraban en orden alterado. La construcción de algunas secuencias se tenía que hacer utilizando asociaciones habituales familiares (condiciones válidas). Por contraste, otras secuencias requerían hacer caso omiso de la selección de tales asociaciones, que eran inapropiadas dentro del contexto general de la tarea (condiciones inválidas). 2) Utilizando el test de ejecución continua, se evaluaron cuatro aspectós: atención sostenida, atención selectiva, preparatión de la atención y atención supresiva. Resultados. Las únicas dife-rencias de grupo en los resultados de las pruebas neuropsicológicas fueron las siguientes: 1) La tarea de ordenación de oraciones. En comparación con el grupo de control, el grupo desinhibido mostraba deficiencia en las condiciones inválidas y la diferencia calculada entre el número de respuestas correctas en las condiciones inválidas menos el número correspondiente en las condiciones válidas era significativamente más alto, y 2) el test de ejecución continua. Los sujetos desinhibidos tenían un número significativamente más bajo de éxitos, exclusivamente en el paradigma de “atención supresiva”. Estos resultados indican que la función del sistema supervisor de los sujetos con desinhibición está deteriorada.

Keywords

comportamientocognicióndesinhibiciónancianosfrontalsupervisión
Type
Artículo original
Information
European Psychiatry (Ed. Española) , Volume 8 , Issue 1 , February 2001 , pp. 27 - 37

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

Bibliografía

Alexander, GECrutcher, MDFunctional architecture of basal ganglia circuits: neural substrates of parallel processing. Trends Neurosci 1990; 13: 266–71.CrossRefGoogle ScholarPubMed
Alexander, GECrutcher, MDDelong, MRBasal ganglia-thalamocortical circuits: neural substrates of parallel processing. Prog Brain Res 1990; 85: 119–46.CrossRefGoogle Scholar
Alexopoulos, GSAbrams, RCYoung, RCShamoian, CACornell scale for depression in dementia. Biol Psychiatry 1988; 23: 271–84.CrossRefGoogle ScholarPubMed
Aubin, VJouvent, RWidlocher, DDarcourt, GModelisation hypothetique du deficit serotoninergique chez le sujet age. L'Encephale 1993; 19: 37–46.Google Scholar
Baddeley, ADHitch, GWorking memory. In: Bower, GA Ed. The psychology of learning and motivation. New York: Academic Press; 1974, p. 47–89.Google Scholar
Baddeley, ADWilson, BAFrontal amnesia and the dyse-xecutive syndrome. Brain Cogn 1988; 7: 212–30.CrossRefGoogle ScholarPubMed
Baddeleye, ADDelia, Sala SPapagno, CSpinnler, HDual-task performance in dysexecutive and nondysexe-cutive patients with a frontal lession. Neuropsychology 1997; 11: 187–94.CrossRefGoogle Scholar
Baddeley, ADThe central executive: a concept and some misconceptions. J Int Neuropsychol Soc 1998; 4: 523–6.CrossRefGoogle ScholarPubMed
Barratt, ESStanford, MSKent, TAFelthous, ANeuropsychological and cognitive psychophysiological substrates of impulsive aggression. Biol Psychiatry 1997; 41: 1045–61.CrossRefGoogle ScholarPubMed
Benton, ALDifferential behavioral effects in frontal lobe disease. Neuropsychologia 1968; 6: 53–60.CrossRefGoogle Scholar
Benton, ALFocal brain damage and the concept of localization of function. In: Loeb, C Ed. Studies in cerebrovascular disease. Milan: Masson Italia Editore; 1981.Google Scholar
Burgess, PWShallice, TFractionnement du syndrome frontal. Rev Neuropsychol 1994; 4: 345–70.Google Scholar
Burns, AFolstein, SBrandt, JFolstein, MClinical assessment of irritability, aggression and apathy in Huntington and Alzheimer disease. J Nerv Ment Dis 1990; 178: 20–6.CrossRefGoogle ScholarPubMed
Burns, AJacoby, RLevy, RPsychiatric phenomena in Alzheimer disease. IV: disorders of behaviour. Br J Psychiatry 1990; 157: 86–94.Google Scholar
Caine, EDDiagnostic classification of neuropsychiatric signs and symptoms in patients with dementia. Int Psychogeriatr 1996; 8 Suppl 3: 273–9.CrossRefGoogle ScholarPubMed
Cardebat, DDoyon, BPuel, MGoulet, PJoanette, YEvocation lexicale formelle et semantique chez des sujets normaux: Performances et dynamiques de production en fonction du sexe, de l'age et du niveau d'etude. Acta Neurol Bel 1990; 90: 207–17.Google Scholar
Corcoran, RUpton, DA role for the hippocampus in card sorting? Cortex 1993; 23: 787–90.Google Scholar
Cummings, JLMega, MGray, KRosenberg-Thompson, SCarusi, DAGornbein, TThe Neuro-Psychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994; 44: 2308–14.CrossRefGoogle Scholar
Cummings, JLThe Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology 1997; 48 Suppl 6: 10–6.CrossRefGoogle ScholarPubMed
De Renzi, EVignolo, LAThe token test: a sensitive test to detect disturbances in aphasics. Brain 1962; 85: 665–78.CrossRefGoogle ScholarPubMed
Delia Malva, CStuss, DTD'Alton, JWillmer, JCapture errors and sequencing after frontal brain lesions. Neuropsychologia 1993; 31; 363–72.CrossRefGoogle Scholar
Devanand, DPMiller, LRichards, MMarder, KBell, KMayeux, Ret al. The Columbia University Scale for Psychopathology in Alzheimer's disease. Arch Neurol 1992; 49: 371–6.CrossRefGoogle ScholarPubMed
Devinsky, OMorrell, MJVogt, BAContributions of anterior cingulate cortex to behaviour. Brain 1995; 118: 279–306.CrossRefGoogle ScholarPubMed
Finkel, SICosta, 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 1996; 8 Suppl 3: 497–9.CrossRefGoogle ScholarPubMed
Folstein, MFFolstein, SEMcHugh, PRMini mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98.CrossRefGoogle ScholarPubMed
Gray, JADopamine release in the nucleus accumbens: the perspective from aberrations of consciousness in schizophrenia. Neuropsychologia 1995; 33: 1143–53.CrossRefGoogle Scholar
Hecaen, HRuel, JSieges lesionnels intra-frontaux et deficit au test de fluence verbale. Rev Neurol (Paris) 1981; 137: 277–84.Google Scholar
Kaplan, EFGoodglass, HWeintraub, SThe Boston Naming Test. Boston: publisher; 1987.Google Scholar
Kaplan, EFFein, DMorris, RDelis, DWais-R as a neuropsychological instrument. San-Antonio: the psychological Corporation; 1991.Google Scholar
Lafont, VMedecin, IRobert, PHBeaulieu, F-EKazes, MDanion, JMet al. Initiation and supervisory processes in schizophrenia and depression. Schizophr Res 1998; 34: 49–57.CrossRefGoogle ScholarPubMed
Lecrubier, YBraconnier, ASaid, SPayan, CThe Impulsivity Rating Scale (IRS): preliminary results. Eur Psychiatry 1995; 10: 331–8.CrossRefGoogle ScholarPubMed
Levin, HSHigh, WMGoethe, KESisson, RAOverall, TERhoades, HMet al. The Neurobehavior Rating Scale: assessment of the sequelae of head injury by the clinician. JH Neurol Neurosurg Psychiatry 1987; 50:183–93.CrossRefGoogle Scholar
Lezack, MDNeuropsychological assessment, 2nd ed. New York: Oxford University Press; 1983.Google Scholar
Luria, ARHigher cortical functions in man. English translation of first edition by Haigh, B.New York: Basic Books & Plenum Press; 1966.Google Scholar
Malloy, PBihrle, ADuffy, JCimino, CThe orbitomedial frontal syndrome. Arch Clin Neuropsychol 1993; 8: 185–201.CrossRefGoogle ScholarPubMed
McFie, JThompson, JAPicture arrangement: a measure of frontal lobe function. Br J Psychiatry 1972; 121: 547–52.CrossRefGoogle ScholarPubMed
Mckhann, GDrachman, DFolstein, MKatzman, RPrice, DStadlan, EMet 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: 939–44.CrossRefGoogle ScholarPubMed
Mega, MCummings, JLFrontal-subcortical circuits and neuropsychiatric disorders. J Neuropsychiatry Clin Neurosci 1994; 6: 358–70.Google ScholarPubMed
Mega, MSCummings, JLFiorello, TGornbein, JThe spectrum of behavioral changes in Alzheimer's disease. Neurology 1996; 46: 130–5.CrossRefGoogle ScholarPubMed
Miller, LAMilner, BCognitive risk taking after frontal or temporal lobectomy - II. The synthesis of phonemic and semantic information. Neurospychologia 1985; 23: 371–9.Google ScholarPubMed
Miller, LAImpulsivity, risk taking, and the ability to syn-thesise fragmented information after frontal lobectomy. Neuropsychologia 1992; 30: 69–79.CrossRefGoogle ScholarPubMed
Montgomery, SAAsberg, MA new depression scale designed to be sensitive to change. Br J Psychiatry 1979; 134: 382–9.CrossRefGoogle ScholarPubMed
Nathaniel-James, DAFrith, CDConfabulation in schizophrenia: evidence of a new form. Psychol Med 1996; 26: 391–9.CrossRefGoogle ScholarPubMed
Norman, DAShallice, TAttention to action: willed and automatic control of behaviour. In: Davidson, RJSchwartz, GEShapiroy, D Eds. Consciousness and self-regulation, Vol. 4. New York: Plenum Press; 1986, p. 1–18.Google Scholar
Orgogozo, JMAuriacombe, SSyndrome dementiel. Techniques. Encyclopedie Medico-Chirurgicale, neurolo-gie, 17-056-A-20. Paris: Elsevier Science; 1995, p. 5–50.Google Scholar
Overall, JGornham, DRThe Brief Psychiatric Rating Scale. Psychol Rep 1962; 10: 799–812.CrossRefGoogle Scholar
Owen, AMDownes, JJSahakian, BJPolkey, CERobbins, TWPlanning and spatial working memory following frontal lobe lesions in man. Neuropsychologia 1990; 28: 1021–34.CrossRefGoogle ScholarPubMed
Perret, EThe left frontal lobe .of man and the suppression of habitual responses in verbal categorical behaviour. Neuropsychologia 1974; 12: 323–30.CrossRefGoogle ScholarPubMed
Petrides, MMilner, BDeficits on subject-ordered tasks after frontal and temporal lobe lesions in man. Neuropsychologia 1982; 29: 249–62.CrossRefGoogle Scholar
Reisberg, GBorenstein, JSalob, SPFerris, SHFranssen, EGeorgotas, ABehavioral symptoms in Alzheimer's disease: phenomenology and treatment. J Clin Psychiatry 1987; 48 Suppl 5: 9–15.Google ScholarPubMed
Reitan, RMValidity of the Trail Making Test as an indication of organic brain damage. Percept Mot Skills 1958; 8: 271–6.CrossRefGoogle Scholar
Robert, PHMigneco, VChaix, IBerthet, LKazes, MDansion, JMet al. Use of a sequencing task designed to stress the supervisory system in schizophrenic subjects. Psychol Med 1997; 27: 1287–94.CrossRefGoogle ScholarPubMed
Rosvold, HEMirsky, AFSarason, IBransome, EDJBeck, LHA continuous Performance Test of brain damage. J Consult Psychol 1956; 20: 343–50.CrossRefGoogle Scholar
Roy-Byrne, PScheele, LBrinkley, JWard, NWiatrak, CRusso, Jet al. Adult attention-deficit hyperactivity disorder: assesment guidelines based on clinical presentation to a specialty clinic. Cornpr Psychiatry 1997; 38: 133–40.Google Scholar
Shallice, TBurgess, PWDeficits in strategy applications following frontal lobe damage in man. Brain 1991; 114: 727–41.CrossRefGoogle Scholar
Shallice, TBurgess, PWHigher-order cognitive impairments and frontal lobe lesions in man. In: Levin, HSEisenberg, HMBenton, A Eds. Frontal lobe function and dysfunction. New York: Oxford University Press; 1991, p. 125–38.Google Scholar
Shallice, TBurgess, PWThe domain of supervisory processes and temporal organization of behaviour. Philos Trans R Soc Lond 1996; 351: 1405–11.Google ScholarPubMed
Solanto, MVConners, CKA dose response and time-action analysis of autonomic and behavior effects of methylphenidate in attention deficit disorder with hyperactive children. Psychophysiology 1982; 19: 658–67.CrossRefGoogle Scholar
Stroop, JRStudies of interference in serial verbal reactions. J Exp Psychol 1935; 18: 643–62.CrossRefGoogle Scholar
Stuss, DTBenson, DFThe frontal lobes. New York: Raven; 1986.Google Scholar
Stuss, DTShallice, TAlexander, MPPicton, TWA multi-disciplinary approach to anterior attentional functions. Annals NY Acad Sci 1995; 769: 191–211.CrossRefGoogle Scholar
Stuss, DTAlexander, MPBenson, DFFrontal lobe functions. In: Trimble, MRCummings, JL Eds. Contemporary behavioral neurology. Boston: Butterworth-Heinemann; 1997, p. 169–87.Google Scholar
Sultzer, DLMahler, MECummings, JLVan, Gorp WGHinkin, CHBrown, CCortical abnormalities associated with subcortical lesions in vascular dementia: clinical and PET findings. Arch Neurol 1995; 52: 773–80.CrossRefGoogle Scholar
Sultzer, DLMahler, MEMandelkern, MACummings, JLVan, Gorp WGThe relationship between psychiatric symptoms and regional cortical metabolism in Alzheimer's disease. J Neuropsychiatry Clinical Neurosci 1995; 7: 476–84.Google ScholarPubMed
Troyer, AKMoscovitch, MWinocur, GClustering and switchings as two components of verbal fluency: evidence fron younger and older healthy adults. Neuropsychology 1997; 11: 138–46.CrossRefGoogle Scholar
Webster, JGrossberg, GTDisinhibition, apathy, indifference, fatigability, complaining and negativism. Int Psychogeriatr 1996; 8 Suppl 3: 403–8.CrossRefGoogle ScholarPubMed
Wechsler, DWechsler Adult Intelligence Scale-revised test manual. New York: Psychological Corporation; 1981.Google Scholar
Wheeler, MAStuss, DTTulving, EToward a theory of episodic memory: the frontal lobes and autonoetic consciousness. Psychol Bull 1997; 121: 331–54.CrossRefGoogle Scholar
World, Health OrganizationThe ICD-10 classification of mental and behavioral disorders: clinical descriptors and diagnostic guidelines. Geneva: WHO; 1992.Google Scholar
Zaudig, MBehavioral disturbances of dementia in DSM-IV and ICD-10: fact or fiction? Int Psychogeriatr 1996; 8 Suppl 3: 285–7.CrossRefGoogle ScholarPubMed