[Cognitive disorders and falls: experience of the Lille multidisciplinary falls service]. / Troubles cognitifs et chutes: l'expérience de la consultation multidisciplinaire de la chute de Lille.

BACKGROUND: Falls and dementia are two major public health problems which concern the elderly population. Cognitive impairment, as a result of Alzheimer's disease or non-Alzheimer dementia, is recognized as a risk factor for falling. Through the experience of the Multidisciplinary Falls Consultation, our aims were first, to evaluate the prevalence of a cognitive decline among outpatients who consult for falls, and second, to determine whether the cognitive impairment was known and diagnosed before the consultation or not. METHODS: Data concerning the first 300 outpatients who completed the initial evaluation are reported. Each patient was assessed by a geriatrician, a neurologist, and a physiatrist, who visited him or her at home. Cognitive impairment was defined as a Mini-Mental State Examination (MMSE) score<24. RESULTS: Of the 300 patients, 228 patients completed the initial evaluation. Among them, 97 (42.5 percent) had a MMSE score<24; 55 had mild stage dementia (MMSE score between 23 and 18) and 42 were at a moderate or severe stage (MMSE score< or =17/30). The cognitive decline was not diagnosed before the consultation in 80 of the 97 patients (82 percent). CONCLUSION: The findings show that a large proportion of old persons presenting with gait disturbance at the Multidisciplinary Falls Consultation have an underlying cognitive decline. Assessment of cognitive functions is required in every elderly faller.

Plasma levels of VLDL- + LDL-cholesterol, HDL-cholesterol, triglycerides and apoproteins B and A-I in a healthy population--influence of several risk factors.

Plasma apo B and apo A-I were determined in 477 subjects (206 males and 271 females) by laser immuno-nephelometry. Measurements of VLDL- + LDL-cholesterol, HDL-cholesterol and triglycerides were done simultaneously. VLDL- + LDL-cholesterol and apo B values were similar in males and females and increased with age. HDL-cholesterol and apo A-I values were higher in females but stable with age. Different regression curves (HDL-cholesterol vs apo A-I) were obtained in males and females and a negative correlation was found between HDL-cholesterol or apo A-I and triglycerides. Increased body weight was associated with higher values of VLDL- + LDL-cholesterol, apo B and triglycerides in both sexes but lower values of HDL-cholesterol and apo A-I essentially in males. Finally, the study provides evidence of a relationship between smoking and alcohol consumption on the one hand, and HDL-cholesterol and apo A-I on the other.

Long-term efficacy and tolerability of simvastatin in a large cohort of elderly hypercholesterolemic patients.

The long-term efficacy and tolerability of simvastatin, a 3-hydroxy-3-methylglutaryl-co-enzyme A (HMG-CoA) reductase inhibitor, was assessed during a 24-month follow-up period in 168 elderly hypercholesterolemic patients. After completing a 4 week double blind dose ranging study with simvastatin, 47 males and 122 females over 62 years of age with type II hyperlipidemia, a total cholesterol level above 6.5 mmol/l and clinically manifest cardiovascular disease were included in this extended study. A total of 159 patients completed the 12-month follow-up period and 141 patients were monitored over the full 24 months. All patients were started on 10 mg simvastatin once daily and the dosage was increased until the target levels of low density lipoprotein (LDL) cholesterol between 2.3 mmol/l (90 mg/dl) and 3.6 mmol/l (140 mg/dl) were reached. Fifty percent of patients reached the targeted LDL cholesterol goal of < 3.6 mmol/l (140 mg/dl) during the study. At study completion, 65 patients (39%) were taking 40 mg simvastatin per day, 56 patients (33%) 20 mg, 42 patients (25%) 10 mg and 5 patients (3%) only used 5 mg per day. Sixteen patients (9%) received concomitant lipid lowering therapy. Over 2 years, the mean decrease in LDL cholesterol ranged from 36% to 38%, the median decrease in triglycerides was 12% to 19% and the mean increase in high density lipoprotein (HDL) cholesterol ranged from 9% to 10%, respectively. Seven patients discontinued simvastatin because of adverse clinical or laboratory events, but only in two (1.1%) was this considered to be drug-related. Side-effects were mild and most frequently gastrointestinal in nature. Mean changes in asparate aminotransferase (AST) were not significantly different from zero and mean changes in alanine aminotransferase (ALT) and creatine phosphokinase (CPK) showed a small increase. We conclude that simvastatin is an efficacious and well-tolerated treatment for hypercholesterolemia in elderly individuals for extended periods.

Inhibition enzyme immunoassay, application to human apolipoprotein B.

Inhibition enzyme immunoassay was applied to human apolipoprotein B (apo-B) from plasma. The technical conditions of the assay were determined. The detection limits of the assay were 200 ng to 10 microgram/ml. Correlation coefficients obtained between enzymoassay and rocket immunoelectrophoresis on one hand and radial immunodiffusion on the other were respectively 0.84 and 0.80. The inhibition enzymoassay provides a specific and highly sensitive method for the quantitation of apo-B.

Association between anticardiolipin antibodies and mortality in patients with peripheral arterial disease.

PURPOSE: Anticardiolipin antibodies may be associated with recurrent thromboembolic events in patients with myocardial infarction or stroke. We sought to determine the prevalence of anticardiolipin antibodies in patients with peripheral arterial disease and their association with subsequent thromboembolic events and mortality. METHODS: We ascertained anticardiolipin antibodies using a standardized enzyme-linked immunosorbent assay (immunoglobulin G [IgG] anticardiolipin > or =15 GPL units or IgM anticardiolipin > or =15 MPL units) in 232 patients with peripheral arterial disease and 100 control subjects. Patients were observed to determine overall and cardiovascular mortality, and incident thromboembolic events. RESULTS: IgG anticardiolipin antibodies were significantly more common in the patients with peripheral arterial disease (36 of 232 [16%]) than in the controls (7 of 100 [7%], P = 0.03). During a median follow-up of 3.5 years, 3 of the 232 patients were lost to follow-up and 56 (24%) died. Overall mortality was significantly greater in the IgG anticardiolipin-positive patients (16 of 35 [46%]) compared with those who were IgG anticardiolipin-negative (40 of 194 [21%], P = 0.0003), largely due to an increase in cardiovascular mortality among the IgG anticardiolipin-positive patients. In a multivariate proportional hazards analysis, IgG anticardiolipin antibodies were an independent risk factor for overall mortality (hazard ratio [HR] = 2.1, 95% confidence interval [CI]: 1.2 to 4.0) and cardiovascular mortality (HR = 4.4, 95% CI: 1.6 to 12). CONCLUSIONS: IgG anticardiolipin antibodies are common in patients with peripheral arterial disease and are associated with an increased risk of overall and cardiovascular mortality.

Intraindividual variability in orthostatic blood pressure changes among older adults: the influence of meals.

OBJECTIVES: To examine the influence of time of day and of meals on postural blood pressure (BP) changes in older adults. DESIGN: Prevalence study of BP changes in response to orthostasis. SETTING: A geriatric short-stay department PARTICIPANTS: A total of 126 inpatients (91 women and 35 men; mean age: 81.4+/-7.9, range 61-95 years) were included in the study. MEASUREMENTS: Two sets of BP and heart rate measurements were obtained for each subject by one examiner using a standard mercury manometer: (1) in mid-morning (between 10:00 and 10:30 a.m.) and (2) within 30 to 60 minutes after lunch (between 1:00 and 1:30 p.m.). Orthostatic hypotension (OH) was defined as a systolic blood pressure (SBP) decline > or = 20 mm Hg within 3 minutes after standing. RESULTS: Sixty-one participants (48%) experienced significant orthostatic BP decline on at least one reading. Among them, 46 (37%) had OH in the mid-morning, and 32 (25%) had OH after lunch (P = .05). Only 17 (13%) had OH on both readings (persistent OH). Forty-four patients (35%) had variable OH. Patients with persistent OH were more likely to exhibit symptoms of dizziness and had a lower body mass index and a higher mean basal supine SBP. There was a positive correlation between basal supine SBP and postural SBP decline. CONCLUSIONS: Because of the variability of postural BP changes, the diagnosis of OH should not be based on a single orthostatic BP measurement but requires repeated testing, at best under circumstances similar to those in which the symptoms occurred. The postprandial period is not particularly favorable to OH, suggesting that the ingestion of a meal does not worsen orthostatic BP changes in most aged patients.

Ambulatory blood pressure monitoring and postprandial hypotension in elderly persons with falls or syncopes.

BACKGROUND: Postprandial hypotension (PPH) is increasingly recognized as a common cause of falls and syncope in elderly persons. Noninvasive ambulatory blood pressure monitoring (ABPM) has been recommended for detecting PPH. This study investigates postprandial blood pressure (BP) changes by means of ABPM in elderly patients experiencing falls or syncopes. METHODS: Twenty-four-hour ABPM was performed in 156 inpatients (111 women, mean age 80.4 +/- 8.1 years). Among them, 45 had been admitted for falls and 75 for syncope; 36 with no history of falls or syncope served as controls. Postprandial change in systolic blood pressure (deltaSBP) was calculated by subtracting the mean SBP within the 2 hours following the meal from the mean SBP within the 2 hours preceding the meal. PPH was defined by a deltaSBP > or = 20 mm Hg. RESULTS: For the entire group, mean SBP decreased after the three meals. On average, the decline in SBP was greater after breakfast than after lunch or dinner, and the number of patients experiencing PPH was greater after breakfast. Average maximal deltaSBP was significantly larger in the syncope group than in the other groups ( p < .05). Moreover, the number of patients experiencing PPH was significantly higher in the syncope/fall group than in the control group (23% vs 9%; p = .03). Compared with patients without PPH, patients with PPH were more likely to have a history of diabetes mellitus (p < .01) or to use more than three different drugs daily ( p = .04), and they showed greater daytime SBP variability (p < .0001). Furthermore, there was a strong positive correlation between preprandial SBP and deltaSBP after breakfast. CONCLUSIONS: About one out of four elderly patients with falls or syncope experiences PPH, usually after breakfast. Postprandial decline in BP contributes to BP variability. deltaSBP and preprandial SBP are positively correlated.

White matter magnetic resonance imaging hyperintensity in Alzheimer's disease: correlations with corpus callosum atrophy.

We have previously demonstrated with MRI that as well as marked white matter involvement in late-onset Alzheimer's disease (AD), atrophy of the corpus callosum may also be present. This finding prompted us to study possible correlations between atrophy of the corpus callosum and white matter hyperintensity (WMH) and between white matter lesions and the severity of the disease. We compared the corpus callosum and white matter lesions on MRI from 15 AD patients and 15 controls. The white matter lesions were scored according to the Scheltens' rating scale. We found a significant reduction of the area of the corpus callosum and more severe white matter lesions in AD patients than in controls. Both atrophy of the corpus callosum and the severity of lesions depended mainly on the diagnosis of senile dementia of the Alzheimer type and on age but not on the diagnosis of presenile AD. We demonstrated a negative correlation between white matter lesions scores and areas of corpus callosum in AD patients and no correlation between the white matter lesions and the severity of the disease. We demonstrated that white matter lesions including WMH and atrophy of the corpus callosum are more frequent in AD than in controls. The predominance of white matter lesions in senile AD may be explained by the combination of aging and disease processes.

[Metabolic study of 3 lipid emulsions used parenteral feedings. I. Exploration in vivo in the minipig]. / Etude métabolique de trois émulsions lipidiques utilisées dans l'alimentation parentérale. I. Exploration in vivo chez le miniporc

The metabolism of three fat emulsions (Lipiphysan, Trive 1000, Intralipid) was compared when administered by intravenous route as complete parenteral nutrition in minipigs during 14 days. With Lipiphysan, an important accumulation of glycerides appeared in liver, spleen and lung whereas the phospholipids content of those tissues was unchanged. The three fat emulsions determined an increase of linoleic acid (18:2) percentages in glycerides and phospholipids of several tissues: liver, heart, lung, spleen and kidney. Moreover, at the level of phosphatidyl-ethanolamine (PE) in liver tissue, the three fat emulsions induced a decrease of some polyunsaturated fatty acids (C20 and C22) percentages. The observed differences in the amount of liver triglycerides between the three fat emulsions seem to be related with the removal mechanisms which appear to be dependent on each fat emulsion. In fact, all tissue lipid analyses showed an increase of 18:2 percentages which agree with an uptake of the different fat emulsions used. The decrease of polyunsaturated fatty acids percentages in PE might be due to an inhibition of elongationdesaturation system or a degradation of those fatty acids.

[Metabolic study of 3 fat emulsions for intravenous nutrition. II. Study by isolated rat liver perfusion]. / Etude métabolique de trois émulsions lipidiques utilisées dans l'alimentation parentérale. II. Etude par perfusion de foie de rat isolé

With a model of isolated rat liver perfusion, the authors study the removal kinetic of three different fat emulsions. In experiments done with Lipiphysan, triglyceride uptake by liver is linear with a rate of 30 mg/h until the 60th minute; after blockade of the reticuloendothelial system (RES), triglyceride uptake is greatly reduced. In standard experiments done with Intralipid and Trive 1000, triglyceride content of the perfusate does not vary significantly; however, the study of free fatty acids removal done before and after liberation of hepatic triglyceride lipase by heparin seems to show that Intralipid triglycerides are slightly hydrolyzed by hepatic triglyceride lipase. The particles of Lipiphysan might be capted directly by RES cells (fast removal), whereas Intralipid might be slightly hydrolyzed (slow removal); Trive 1000 removal appears to be slow and similar to Intralipid. Those results give some explanations on data obtained in vivo in minipigs and agree with a better use of Intralipid and Trive 1000 triglycerides by extrahepatic sites.

[Lipoprotein electrophoresis on acrylamide-agarose plates, with discontinuous acrylamide gradient]. / Electrophorese des lipoproteines seriques sur plaque de gel d'acrylamide-agarose, en gradient discontinu d'acrylamide.

We describe a modified lipoprotein electrophoresis on acrylamide gel. The lipoproteins, prestained with Sudan Black, are separated by running on acrylamide-agarose gels, with two different concentrations of acrylamide and a constant concentration of agarose. The sera are deposited in the first gel (2% acrylamide). Chylomicrons remain at origin and other lipoproteins run through the first gel to the second one (3% acrylamide gel). VLDL stays at the junction of both gels, LDL and HDL are separated in the 3% acrylamide gel. By this technique, we were able to detect an increase of Lp(a) and to identify the different types of hyperlipoproteinemia. After running, the plates can be treated for storage.

Immunochemical determination of human apolipoprotein B by laser nephelometry.

The Hyland laser nephelometer PDQ system for the assay of apolipoprotein B (apo-B) in human serum is described. Within and between-batch precision, accuracy and reliability are discussed. This instrument represents an important development in the immunochemical assay of apo-B, and the speed, precision, and convenience of the methodology make such a system attractive. Quantitation of apo-B was assessed in normal and hyperlipaemic subjects. Comparisons were made with two other specific and sensitive immunological methods for quantifying apo-B: enzymeimmunoassay (EIA) and rocket immunoelectrophoresis (RIE). Results obtained by the three methods correlated very well.

[Exact determination of the lecithin/sphingomyelin ratio in amniotic fluid. Suggestion of a reference methods (author's transl)]. / Determination precise du rapport lecithine/sphingomyeline dans le liquide amniotique: Proposition d'une methode de reference.

Pulmonary maturity of the fetus can be evaluated by the lecithin/sphingomyelin (L/S) ratio in amniotic fluid. To existing methods of lipid extraction, precipitation with acetone and chromatography, we add a simple and accurate estimation of sphingomyelins (S) and precipitated lecithins (Lp) without acid digestion. The method is reproducible (C.V. less than 9%) for the measurement of Lp/S ratio and gives with accuracy the concentrations of Lp, avoiding possible errors in interpretation of Lp/S. Our results show that at 35 weeks of normal gestation, Lp/S ratio is about 2 and Lp concentration, 10 mg/1.

Changes in rat heart phospholipid composition after rapeseed oil feeding.

The influence of long duration rapeseed oil feeding with high or low levels of erucic acid has been investigated on rat heart phospholipids. The rats treated for 20 wk with rapeseed oil containing 46.2% erucic acid showed a twofold increase in the sphingomyelin content of the heart. Treatment with primor rapeseed oil (3.7% erucic acid) for 20 wk did not modify phospholipid composition of rat heart. The fatty acid patterns of phosphatidylethanolamine and phosphatidylcholine were slightly influenced by the high erucic rapeseed oil; eicosenoic acid was incorporated preferentially into position one, but erucic acid showed a random distribution in both. After high erucic rapeseed oil feeding, 22:1 was incorporated into cardiolipin (5.6%) and sphingomyelin (10.5%). The incorporation of 22:1 into sphingomyelin was associated with an increase of the percentage of 24:1 (14.6%) and a decrease of saturated long chain fatty acid (22:0, 24:0) percentages. Primor rapeseed oil caused a slight increase of 24:1 and a decrease of 22:0 and 24:0 in rat heart sphingomyelin. As cardiolipin is localized in the inner membrane of mitochondria and sphingomyelin in plasma and microsomal membranes, the acyl-moiety alterations of both phospholipids might be correlated to the pathological lesions of rat heart after a long duration of rapeseed oil feeding.

Changes in fatty acid composition of cardiac mitochondrial phospholipids in rats fed rapeseed oil.

Male Wistar rats were fed rapeseed oil containing high or low levels or erucic acid for 20 weeks, and changes in the fatty acid composition of cardiac mitochondrial phospholipids were studied. Treatment with rapeseed oil containing 46.2% erucic acid showed incorporation of 22:1 (5.6%) into isolated cardiolipin from heart mitochondria. After high or low (3.7%) erucic rapeseed oil feeding, linolenic acid was slightly incorporated into cardiolipin. Moreover, both of these rapeseed oils induced a significant increase of linoleate-arachidonate ratio in phosphatidylethanolamine and phosphatidylcholine. This ratio was also significantly increased in fatty acids esterified to the beta-position of these phospholipids. On the basis of such results, we have to consider the role of linolenic acid which is present at a high level in the different rapeseed oils used, as a possible inhibitor of heart microsomal enzymes involved in linoleate arachidonate conversion. Such alterations might account for mitochondrial fragility and myocardial lesions obtained in long term rapeseed oil feeding experiments.

[Congestive cardiomyopathy associated with a stiff spinal column. "Rigid spine syndrome"]. / Cardiomyopathie congestive associée à un syndrome de la colonne raide. "Rigid spine syndrome".

The "rigid spine syndrome" is a rare form of myopathy characterised by rigidity of the dorso-lumbar spine, hyperextension of the neck and muscular retraction limiting mobility, especially of the upper limbs with elbows fixed in semi-flexion. This condition, which was first described relatively recently, has been little studied: only 8 cases have been published to this day. We report the case of a 20 year old man with this syndrome, associated with a severe diffuse non-obstructive hypertrophic cardiomyopathy. Electronic microscopy and histoenzymological studies were performed on the skeletal muscle. They confirmed myopathic changes, demonstrating a great variation in diameter of the fibres, but there was no evidence of a predominating histoenzymological form (type I muscular atrophy) as previously reported. Although there have been no other reports of cardiac involvement in the "rigid spine syndrome", a link between the two conditions would seem to be likely.

[Diagnosis of type III hyperlipoproteinemia: contribution of an air-driven ultracentrifuge associated with an original tube-slicer (author's transl]. / Diagnostic de l'hyperlipoprotéinémie de type III: apport d'une ultracentrifugeuse à turbine à air associée à un coupe-tube de conception originale.

Diagnosis of type III hyperlipoproteinemia requires preparative ultracentrifugation in order to measure the cholesterol/triglyceride molar ratio into isolated d less than 1.006 lipoproteins. The authors describe an ultracentrifugation micromethod which needs 600 microliter of serum and can be completed within three hours (Airfuge Beckman instruments). An original tube-slicer allows the separation of the d less than 1.006 lipoproteins located into top fractions. This simple micromethod might confirm diagnosis of type III in patients and would be useful for clinical laboratories.

[Analysis of lipoproteins using polyacrylamide gel electrophoresis and fractionated precipitation with polyanions and detergents. Use in the classification of hyperlipoproteinemias]. / Analyse des lipoprotéines par électrophorèse sur gel de polyacrylamide et par précipitation fractionnée à l'aide de polyanions et de détergents. Application au typage des hyperlipoprotéinémies

Sodium dodecylsulphate precipitates very low density lipoproteins (VLDL and chylomicrons) rich in triglyceride and a narrow correlation (r = 0.9) was found between the turbidimetric index SDS and triglyceridemia. Heparin in calcium medium acts in the same way and precipitates also low density lipoproteins (LDL) rich in cholesterol. A correlation (r = 0.875) was drawn up between the cholesterol LDL and the difference between the turbidimetric indices (heparin Ca -- SDS). In the first case, we were thus measuring by turbidimetry a VLDL + chylomicron index and, in the second case, an LDL index which permits one to obtain simplified typing of the hyperlipoproteinemias. A nomogram linking the two indices of hyperlipoproteinemia type was drawn up experimentally. This orientation analysis may be completed by electrophoresis on polyacrylamide gel used in concentration gradient and pH. In the system proposed, the lipoproteins were previously stained with tetrazolium nitroblue and clearly shown up. The chylomicrons in particular, become separated from the VLDL, the sinking pre-beta-lipoprotein or Lp (a) was identifiable and the type III hyperlipemia was easily diagnosed.

[Automation of fluorometric enzymatic determination of free and total cholesterol. Application to the determination of the esterification rate]. / Automatisation en fluorimétrie du dosage enzymatique du cholestérol libre et total. Application à la détermination du rapport d'estérification

A fluorimetric, authomatical method for determination of free and total cholesterol in serum is described. Cholesterol esters are splitted into free cholesterol and fatty acids by cholesterol esterase. In the presence of oxygen free cholesterol will be transformed by cholesterol oxydase in delta 4 cholestenone with formation of hydrogen peroxyde. Hydrogen peroxyde oxidizes in the presence of catalase inethanol to formaldehyde which gives with ammonium ions and acetylacetone 3-5 diacetyl 1-4 dihydrolutidine measured by fluorimetry. Withour cholesterol esterase, the reaction allows a measurement of free cholesterol in plasma. So the ratio of ester to total cholesterol is determined by the two steps. Accuracy and precision are very good. Results are well correlated with those obtained with reference methods.

[Phosphocalcium metabolism in the elderly. Study of 101 subjects living in an institution]. / Etude du métabolisme phosphocalcique de la personne âgée chez 101 sujets vivant en institution.

Calcium and phosphorus metabolism was studied in 101 institutionalized subjects over 70 years of age (mean: 82.5 years). The study was performed in serum and urine; it included parathyroid hormone and calcidiol (250HD3) assays and radiological examination of bones with determination of Meunier's index and metacarpal cortical index. Calcidiol concentrations did not vary with age but were higher in people who left the institution and in men. In contrast, there was a significant age-group related increase of parathyroid hormone concentrations. This increase was accompanied by an increase of parathyroid hormone activity, as shown by a parallel fall in phosphorus reabsorption rate. These findings are in agreement with current pathogenetic theories on senile osteoporosis. Invalid subjects had higher urinary calcium and serum parathyroid hormone levels and a lower cortical index. Paradoxically, there was less vertebral collapse as evaluated by Meunier's index, which may suggest that very old patients develop progressive cortical bone hyperresorption entirely independent of sequelae from their former trabecular osteoporosis.