[Sleep apnea syndrome and cognitive impairment]. / Syndrome d'apnées du sommeil et troubles cognitifs.

The sleep apnoea syndrome is a common disorder, unrecognised in the elderly. Several studies have shown that it can cause or exacerbate cognitive impairment, mainly related to attention, memory and learning and adaptation abilities. However, continuous positive airway pressure treatment appears to be effective on these cognitive disorders, including in elderly patients.Accordingly, the sleep apnoea syndrome can be a conceivable diagnostic as part of the cognitive deterioration check-up in elderly patients.

[Management of Alzheimer disease]. / Prise en charge de la maladie d'Alzheimer.

Management of Alzheimer disease is based on drug and nondrug treatments. Specific drug treatment includes acetylcholinesterase inhibitors and memantine. They show moderate efficacy superior to that of placebo for global condition, cognitive disorders, need for care, and behavioral problems, but do not prevent further decline. These treatments remain underused. The efficacy of psychotropic drugs (antidepressants, neuroleptics, and antipsychotic agents) in treating behavioral problems is not well documented. Nondrug activities and interventions have not been sufficiently evaluated scientifically. These involve interventions against the consequences of the disease (loss of autonomy, malnutrition) and helping patients' family caregivers. Among these activities, the best evaluated and most interesting are: educational programs for caregivers, occupational therapy at home, and interventions at home by nurses specially trained as case managers.

[Dementia syndromes in the elderly: diagnostic procedures]. / Syndromes démentiels du sujet âgé: démarches diagnostiques.

Dementia is a deterioration in several cognitive functions that affects daily living and is observed in the absence of impaired vigilance. Dementia may be revealed by symptoms of memory loss but also by a loss of functional autonomy, onset of depression or by behavioral problems; it may also be recognized during a screening examination. Evaluation of cognitive functions is an essential stage of this diagnosis. Simple tests that any physician can perform provide a first approach. A more detailed cognitive evaluation by a specialist or neuropsychologist is then necessary (except in advanced cases). Once dementia is diagnosed, a causal investigation is required to assess its severity and extent, in order to organize management. Lack of recognition of dementia in the elderly and delay in its diagnosis raise the question of screening to detect it at an earlier stage.

The cognitive disorders examination (Codex) is a reliable 3-minute test for detection of dementia in the elderly (validation study on 323 subjects).

BACKGROUND: Dementia often remains undiagnosed until it has reached moderate or severe stages, thereby preventing patients and their families from obtaining optimal care. Tools that are easy to use in primary care might facilitate earlier detection of dementia. AIM: Develop and validate a very brief test for the detection of dementia. METHODS: In the derivation study, we recorded educational level, Mini Mental State Examination (MMSE) scores and subscores and results of a simplified clock-drawing test (sCDT) for consecutive patients attending a single memory clinic over a two-year period,. Dementia was diagnosed according to DSM-IV criteria. The independent variables related to dementia were determined by a multivariable logistic model (MLM) and used to develop a decision tree to predict this diagnosis. In the validation study, the decision tree was applied to consecutive patients of six memory clinics for whom status about dementia was previously determined with DSM-IV criteria. The decision tree, MLM, and MMSE were applied to detect dementia in these patients. The sensitivity and specificity of each diagnostic tool were estimated and compared. RESULT: Of 242 patients in the derivation study, the following independent variables were correlated with dementia: sex, sCDT, and two MMSE subscores - the 3-word recall test and spatial orientation. We used Bayesian statistics to develop a brief 2-step decision analysis tree (2-3 min.), which we named Codex (cognitive disorders examination). The validation study applied Codex to 323 patients. Sensitivity was 93% and specificity 85%. The corresponding values were 88% and 87% for the MLM, 94% and 67% or 91% and 70% for the MMSE, depending on the MMSE cutoff score. The sensitivity of Codex was significantly higher than that of MLM, and its specificity was significantly greater than that of MMSE. CONCLUSION: Codex is a simple, brief, and reliable test for detecting dementia and requires three minutes or less to administer. Its simplicity and brevity make it appropriate for and easy to use in primary care.

[Depression: an underrated consequence of stroke in elderly]. / La dépression: une complication méconnue de l'accident vasculaire cérébral chez les sujets âgés.

Stroke is a major cause of morbidity, disability and hospitalization in the elderly. Depression frequently occurs after stroke and influences functional recovery, a crucial factor for the prognosis. The physiopathology of post-stroke depression is not entirely elucidated and might involve several mechanisms: direct consequences of brain lesions, especially in certain localizations, neuroendocrine mechanism or psychological reaction to a life event responsible for stress and handicap. Antidepressant drugs improve depressive symptoms and functional recovery. Therefore, search for depression should be systematic early at the stroke reeducation phase to instaure appropriate treatment.