Visual Loss and Subsequent Activity Limitations in the Elderly: The French Three-City Cohort.

OBJECTIVES: To investigate the relationship between vision and disability in the elderly. METHODS: We used a baseline visual indicator (combining near acuity with Snellen equivalent < 20/30 and self-reported distance visual loss) to explore the association between visual loss and subsequent disability (mobility, instrumental activities of daily living [IADLs], ADLs, and participation restriction) from 1999 to 2007 in 8491 elderly participants of the French Three-City Cohort (Bordeaux, Dijon, and Montpellier). RESULTS: In multiadjusted analyses, near visual impairment, alone or associated with distance visual function loss, was associated with greater risk of developing ADL limitations (P = .027), IADL limitations (P = .002), and participation restriction (P < .001), but not mobility (P = .848). The disabling impact of visual loss was significant for 11 of the 15 activities, when analyzed one by one. CONCLUSIONS: Both near and distance visual loss was associated with greater functional decline over time, and the combination of the two could be even worse. Public Health Implications. In the context of rapid aging of the population, maintaining good vision in the elderly represents a promising prevention track, visual impairment being common in the elderly, largely undermanaged, and mostly reversible. Further research, especially trials, is necessary to estimate the public health impact of such interventions.

Psychological transition and adjustment processes related to retirement: influence on cognitive functioning.

OBJECTIVE: To investigate the relationship between psychological transition and adjustment to retirement and cognitive performances in older adults. METHODS: The study's sample was taken from the Approche Multidisciplinaire Intégrée cohort, a French prospective study of retirees from agriculture, aged 65 and over, living in rural settings in southwestern France. The cross-sectional analyses were conducted on a sample of 590 elderly people without dementia at baseline and for whom information on perception of the work setting, experience of the retirement transition and adaptation to retirement life (nine variables) as well as neuropsychological measures (global cognitive functioning, episodic memory, verbal fluency, attention and psychomotor speed) were available at first visit. RESULTS: Multivariable linear regression analyses, including nine variables related to retirement and adjusted for potential confounding factors, indicated that three of them - positive consideration of former work situation, development of new activities during retirement and good adaptation to free time - were associated with better cognitive performances. CONCLUSIONS: We found that several factors proved to be determinants of good cognitive functioning at retirement and could serve as a basis for the development of more efficient intervention programs aimed at helping retirees to maintain good cognitive functioning after retirement.

Health and aging in elderly farmers: the AMI cohort.

BACKGROUND: The health of the agricultural population has been previously explored, particularly in relation to the farming exposures and among professionally active individuals. However, few studies specifically focused on health and aging among elders retired from agriculture. Yet, this population faces the long-term effects of occupational exposures and multiple difficulties related to living and aging in rural area (limited access to shops, services, and practitioners). However, these difficulties may be counter-balanced by advantages related to healthier lifestyle, richer social support and better living environment. The general aim of the AMI cohort was to study health and aging in elderly farmers living in rural area through a multidisciplinary approach, with a main focus on dementia. METHODS/DESIGN: The study initially included 1 002 participants, randomly selected from the Farmer Health Insurance rolls. Selection criteria were: being 65 years and older; living in rural area in Gironde (South-Western France); being retired from agriculture after at least 20 years of activity and being affiliated to the Health Insurance under own name. The study started in 2007, with two follow-up visits over 5 years. Baseline visits were conducted at home by a neuropsychologist then by a geriatrician for all cases suspected of dementia, Parkinson's disease and depression (to confirm the diagnosis), and by a nurse for others. A large panel of data were collected through standardised questionnaires: complete neuropsychological assessment, material and social living environment, psychological transition to retirement, lifestyle (smoking, alcohol and diet), medications, disability in daily living, sensory impairments and some clinical measures (blood pressure, depression symptomatology, anxiety, visual test, anthropometry...). A blood sampling was performed with biological measurements and constitution of a biological bank, including DNA. Brain MRI were also performed on 316 of the participants. Finally, the three-year data on health-related reimbursements were extracted from the Health System database (medications, medical and paramedical consultations, biological examinations and medical devices), and the registered Long-Term Diseases (30 chronic diseases 100% covered by the Insurance System). DISCUSSION: AMI is the first French longitudinal study on health and aging set up in a population of elderly farmers living in rural area through a multidisciplinary approach.

Impact of social network on cognitive performances and age-related cognitive decline across a 20-year follow-up.

BACKGROUND: The objective of this study was to investigate the relationship between social network and cognitive decline, taking into account the potential bias of reverse causality. METHODS: The study sample comprised 2055 elderly participants without dementia. We assessed baseline social functioning across four variables: size of social network, satisfaction with relationships, perception of being understood, and participation in social activities. A neuropsychological battery was proposed at baseline and repeated throughout follow-up. Linear mixed models were used to investigate the relationship between social network and baseline cognitive performances and cognitive decline during the 20-year follow-up. RESULTS: When controlling for the reverse causality bias by excluding participants who developed dementia during the study follow-up and after adjusting for covariates, the results showed that better social functioning at baseline was associated with better initial performances in the Isaacs Set Test and the Wechsler Paired Associate Test. However, there was no significant association with further cognitive decline. By contrast, when the bias of reverse causality was not controlled for (i.e. no exclusion of participants who developed dementia), the association between social network and global cognitive decline measured by MMSE was found to be statistically significant. CONCLUSION: With the opportunity to exclude participants who developed dementia, and the particularly long follow-up of participants, we were able to investigate the relationship between social networks and age-related cognitive decline with a minimization of reverse causality bias. The results suggest that even though higher social functioning is concomitantly associated with better cognitive performances, it may not prevent subsequent decline.

What aspects of social network are protective for dementia? Not the quantity but the quality of social interactions is protective up to 15 years later.

OBJECTIVE: To test the association between several social networks variables reflecting both structural characteristics and quality of relationships with the risk of dementia and Alzheimer's disease 5 and up to 15 years later. METHODS: The study sample is gathered from the Paquid cohort, a French population-based study of 3,777 elderly people evaluated at baseline and regularly revisited during a 15-year interval. The sample consisted of 2,089 subjects who completed the social network questionnaire and were free of dementia at the time of enrollment and also at the next two follow-ups to minimize the problem of reverse causality. The questionnaire collected at baseline included marital status, number of ties, nature of social network, satisfaction, perception of being understood/misunderstood, and reciprocity in relationships. RESULTS: The incident cases of dementia considered were those diagnosed at 5-year and subsequent follow-ups, resulting in 461 dementia and 373 Alzheimer's disease cases. The multivariate Cox model, including the six social network variables and adjusted for numerous potential confounders, showed significant associations with satisfaction and reciprocity in relationships. Participants who felt satisfied with their relations had a 23% reduced dementia risk. Participants who reported that they received more support than they gave over their lifetime had a 55% and 53% reduced risk for dementia and Alzheimer's disease, respectively. CONCLUSION: The only variables associated with subsequent dementia or Alzheimer's disease were those reflecting the quality of relationships. The delay between social network assessment and dementia diagnosis was from 5 up to 15 years, thus minimizing the problem of reverse causality.

Near Visual Impairment Incidence in Relation to Diabetes in Older People: The Three-Cities Study.

OBJECTIVES: To characterize the relationship between diabetes mellitus (DM) and future risk of near vision impairment (VI) in a community-dwelling population of older people. DESIGN: Seven-year population-based longitudinal study. SETTING: Three-Cities Study, a French prospective study designed to assess the risk of cognitive and functional decline attributable to vascular factors. PARTICIPANTS: Community-dwelling individuals aged 65 and older (N = 8,412). MEASUREMENTS: DM was determined at baseline according to self-reported DM, antidiabetic treatment, and fasting blood glucose. Near visual acuity was measured at baseline and 2, 4, and 7 years later. Near VI was defined as a Snellen score greater than 20/30. RESULTS: DM was associated with a higher risk of near VI in an adjusted model (hazard ratio (HR) = 1.24, 95% confidence interval (CI) = 1.02-1.52, P = .03). Because of an interaction between Body Mass Index (BMI) and diagnosed DM, the longitudinal analyses were stratified according to BMI category. DM was associated with greater risk of near VI only in underweight (BMI <21.0 kg/m2 , HR = 2.89, 95% CI = 1.18-7.03) and normal-weight (BMI 21.0-24.9 kg/m2 , HR = 1.60, 95% CI = 1.10-2.32), but not overweight (P = .69) and obese (P = .09) subjects. CONCLUSION: DM is a risk factor for near VI in older people, particularly in those with a low or normal BMI. This risk profile should be taken into account in older adults to support their independence.

The TMA-93: A New Memory Test for Alzheimer's Disease in Illiterate and Less Educated People.

The present study aimed at validating the Memory Associative Test of the district of Seine-Saint-Denis (TMA)-93, a new test of episodic memory. The TMA-93 was proposed to mostly less educated and multicultural elderly population composed of 376 healthy controls (HC) and 94 patients with Alzheimer's disease (AD). The construct validity was checked by studying correlations with a widely used memory test (the Free and Cued Selective Reminding Test [FCSRT]) in the subsample of literate patients. Results showed that (i) all the TMA-93 scores of the patients with AD were lower than those of the HC, (ii) the TMA-93 total score identified patients with AD with a high sensitivity (88%) and very high specificity (97%), and (iii) the TMA-93 total score was strongly correlated with both free recall and total recall scores of the FCSRT. Taken together, results showed that the TMA-93 is a reliable tool to assess episodic memory in a multicultural, less educated, or illiterate population, with good construct validity for AD diagnostic accuracy.

Trends in Prevalence of Dementia in French Farmers from Two Epidemiological Cohorts.

OBJECTIVES: To determine the prevalence of dementia and cognitive impairment in older people across generations. DESIGN: Two prospective cohort studies (Personnes Agées QUID (PAQUID), Aging Multidisciplinary Investigation (AMI)). SETTING: Baseline data from two subsamples of older farmers in southwestern France. PARTICIPANTS: PAQUID (n = 595) and AMI (n = 906) participants aged 65 and older living at home at baseline (1988 PAQUID, 2008 AMI). MEASUREMENTS: Two methods were used to diagnose dementia: a clinical consensus diagnosis and a computer-assisted taxonomy approach (cognitive impairment with disability (CIWD)) using Mini-Mental State Examination and instrumental activity of daily living scores. Crude and standardized prevalences (using PAQUID age-sex structure) and 95% confidence intervals were calculated, and logistic regression was used to explore confounding. RESULTS: The prevalence of consensus diagnosis of dementia was higher in AMI in 2008 than in PAQUID in 1988 (12.0% vs 5.7%, P < .001), whereas the reverse was observed for CIWD (14.8% vs 23.8%, P < .001), confirmed by logistic regressions (odds ratio (OR)AMIvsPAQUID = 2.50, 95% confidence interval (CI) = 1.52-4.12; ORAMIvs.PAQUID = 0.60, 95% CI = 0.42-0.87, respectively). Educational level increased and management of vascular risk factors improved over the study period, and health and living conditions improved globally. CONCLUSION: These findings suggest global cognitive and functional improvement in old farmers (the prevalence of CIWD decreased by 40% over 20 years) and simultaneously a marked change in the subjective boundary between dementia and nondementia according to clinicians.

TNI-93: A New Memory Test for Dementia Detection in Illiterate and Low-Educated Patients.

OBJECTIVE: To validate the TNI-93 test in illiterate and low-educated subjects by setting cutoff scores to discriminate non-demented and demented subjects in a clinical setting (CESILL) and verifying the adequacy of these cutoff scores in a population-based study (AMI cohort). METHOD: We used two study samples. First, a clinical setting (CESILL) comprising normal elderly participants and demented patients, mostly multicultural, low educated, or illiterate, was used to compute the cutoff scores of TNI-93 for the detection of dementia. Second, the AMI cohort, a population-based cohort of retired farmers living in a rural setting, was used as a replication study, to assess the detection properties of the cutoff scores in a different population composed mostly of low-educated older people. RESULTS: When combining the two scores, that is, free recall <6 or total recall <9, TNI-93 can detect dementia with a high sensitivity (87%) and specificity (96%), in the CESILL setting. These cutoff scores were roughly similar in the AMI cohort with high sensitivity (80% sensitivity) and specificity (81% specificity). In both study samples, the level of education had no effect on performance. CONCLUSIONS: The TNI-93 appears to be a good test to detect dementia. The absence of a significant effect of education level on the performances makes the TNI-93 a tool of choice in the screening of dementia in illiterate/low-educated subjects.

Are conceptual abilities impaired in schizophrenia?

Whereas semantic processing deficits are well-documented in schizophrenia, conceptual abilities have been poorly explored. This study aims at specifically exploring conceptualization abilities in 34 adults fulfilling schizophrenia according to DSM-IV and 34 healthy controls with similar socio-demographic characteristics. The 2 groups were assessed on the WAIS-R similarities test and the concept generation test (Raoux et al., 2014) consisting of free-sorting 6 cards of pictures of animals and geometric shapes to be separated in two groups or categories based on common attributes. After each sorting, the participant is asked to explain his/her sorting. Whereas the schizophrenic patients performed significantly poorer than the control participants in the semantic knowledge and lexico-semantic tests, there was no difference neither in the WAIS-R similarities test nor in the concept generation test, which supports the hypothesis of preserved high level conceptualization abilities in schizophrenia. However, qualitative differences in performing the concept generation test were evidenced. The patients used more often mixed criteria leading them to compare two different hierarchical levels (e.g., low-level physical attributes vs. high-level semantic criteria). Furthermore, the qualitative analysis based on the explanations provided by the participants shows that the categorizations achieved by schizophrenic patients are more often based on unexpected criteria.

[The DMS 48: norms and diagnostic proprieties for Alzheimer's disease in elderly population from the AMI cohort study]. / Test du DMS 48 : normes chez les sujets âgés et propriétés de détection de la maladie d'Alzheimer dans la cohorte AMI.

UNLABELLED: The DMS 48 is a visual recognition memory test designed to detect memory changes in early Alzheimer's disease (AD). The aim of this study was to produce normative scores for this test and to assess its psychometric properties in the detection of AD by comparison with a widely used test of verbal episodic memory: the story recall task of the Wechsler memory scale. Methods. Data were collected in a sample of 1002 agricultural retirees, aged 65 years and over, included in the AMI study, a population-based cohort conducted in Southwestern France. The sample used to establish normative data included 750 non-demented elderly while the sample used to study the properties of the test to detect AD included 751 participants whose 34 with AD. To assess AD detection accuracy, DMS 48 was compared to the Wechsler story recall task. Results. Age, sex, and education were significantly associated with DMS 48 performances. Therefore, normative scores were calculated according to sex, age, and educational level, and described by percentiles. Regarding the test properties for AD detection, DMS 48 presented a good balance between sensitivity (Se) and specificity (Sp) both for immediate (Se=70.6%; Sp=79.6%) and delayed recall (Se=79.4%; Sp=72.9%). It also showed high negative predictive values, around 98.5% for both recalls. Detection values were roughly similar to that of Wechsler story recall task. CONCLUSION: The DMS 48 seems to be as reliable as the Wechsler story recall task with similar detection properties. The DMS 48 is a test easy to administer in clinical situations and could be a helpful tool for AD screening.

[An alternative word-list for the Free and cued selective reminding test (FCSRT): list presentation and reliability study]. / Validation d'une troisième liste de mots pour l'épreuve Rappel libre/Rappel indicé à 16 items (RL/RI-16) : présentation de la liste C et étude de fidélité

The Free and cued selective reminding test (FCSRT) is one of the most effective neuropsychological test used to assess verbal memory in elderly people with memory problems. There are currently two lists of words: the initial French version (list A) and an alternative one (list B). However, diagnosing early Alzheimer's disease in memory clinics often requires more than two evaluations, particularly in patients with very mild cognitive symptoms and patients with young onset disease. Usually, memory tests can be affected by practice effect, so several expositions of the same list of words could limit its clinical utility. The aim of our study was to create and validate a second alternative version (list C). The study sample was composed of 222 healthy volunteers aged from 17 to 84 years with a mean age of 44.6 years of whom 57% were females and 71% had a higher education. Within a two-month interval, each subject performed the test with one word-list and then the second one. The order of lists presentation was counterbalanced. Our findings indicate that the new alternative list (list C) is equivalent to the initial list of word (list A) for all the recall and recognition subscores, except the number of intrusive errors. This new list of words should be helpful to minimise potential practice effect and better assess memory decline in situations where the FCSRT has to be repeated across follow-up.

Gender differences in the prodromal signs of dementia: memory complaint and IADL-restriction. a prospective population-based cohort.

Subjective memory complaint (SMC) and restriction in cognitively-complex activities of daily living (such as instrumental ADL) are two early symptoms observed in the prodromal phase of dementia and may represent useful alarm signals for general practitioners for an increased risk of subsequent dementia. We here studied in a large population-based epidemiological cohort on aging, the risk of dementia associated with SMC and restriction in IADL, with a specific interest in a potential interaction by gender. The sample included 2,901 subjects, aged 65 years and over, initially free of dementia and followed over 15 years. After controlling for education, marital status, depressive symptomatology, and global cognition (MMSE), IADL-restriction was associated with an increased risk of dementia only in men (HR = 2.04, 1.27 to 3.29), whereas SMC was not (p = 0.95). The reverse was observed in females, in whom SMC almost doubled the risk of dementia (1.48 to 2.41), with no association with IADL-restriction (p = 0.74). Finally, we distinguished the risk of dementia at short-term (in the first 5 years), mid-term (between 5 and 10 years), and long-term (between 10 and 15 years). In women, SMC was significantly associated with greater risk of dementia whatever the risk period considered, even at longer term (HR = 1.61, p = 0.0216), whereas in men the increased risk was also observed with IADL-restriction and only in the first 5 years. To conclude, women would report the first symptoms very early in the process by SMC, whereas men would tend to later report their difficulties and only in terms of IADL-restriction.