RESUMEN
Caring for a relative with a severe mental disorder puts family caregivers to a great risk of depression. While overall caregiving burden is a strong predictor of depression, the contribution of the various dimensions of burden to caregivers' depression as well as their relationships with depressive symptoms has received little attention. 384 family caregivers completed a cross-sectional online survey including the Center for Epidemiological Studies Depression (CES-D) scale, the Zarit Burden Interview (ZBI), and the Brief Experience of Caregiving Inventory (BECI), measuring caregiving burden and experience. We estimated the structure of the relationships between caregiving experiences (i.e., ZBI and BECI subscales) and CES-D symptoms using a network approach. Negative Emotion/Consequences, (lack of) Positive Personal Experience, and Stigma/Effects on Family were the most connected caregiving dimensions to depression. To untangle the role of the Negative Emotion/Consequences component (by far the most central node in estimated networks), a secondary analysis incorporating its composing items was estimated. Losing control over life, feeling strained around the relative and impaired self-perceived health emerged as central nodes. Interestingly, these caregiving-related dimensions or experiences were differentially connected to depressive symptoms. We discuss how these findings might help future research and inform tailored psychoeducational interventions for family caregivers of people with a severe mental disorder.
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Depresión , Trastornos Mentales , Humanos , Estudios Transversales , Depresión/diagnóstico , CuidadoresRESUMEN
Early psychological factors, including childhood traumas and personality, play a crucial role in the emergence and persistence of painful symptoms and appears to be frequent in patients with nociplastic pain. Patient care involves validating the reality of their pain and identifying various facets of their suffering, taking into account their individual history and context. A multimodal therapeutic approach, within a bio-psycho-social model, emphasizing psychotherapeutic care, is recommended.
Les facteurs psychologiques précoces, notamment les traumatismes infantiles et la personnalité, jouent un rôle primordial dans l'émergence et la pérennisation des symptômes douloureux, et sont très fréquemment retrouvés chez les patients atteints de douleurs nociplastiques. La prise en charge des patients passe par la validation de la réalité de leur douleur et l'identification des diverses facettes de leur souffrance, en tenant compte de l'histoire et du contexte individuel. Une approche thérapeutique multimodale, dans un modèle de type biopsychosocial et privilégiant la prise en soins psychothérapeutique, est recommandée.
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Dolor Crónico , Humanos , Dolor Crónico/terapia , Ansiedad , Personalidad , Trastornos de la PersonalidadRESUMEN
INTRODUCTION: Chronic pain (CP) was associated with cognitive impairment in previous studies. However, the longitudinal association between CP and dementia remains under debate. We aimed to assess the prospective link between CP and long-term dementia risk in a population-based cohort of older participants, considering covariables linked to CP and cognitive functioning. METHODS: The study sample was selected from the PAQUID study, an ongoing cohort of older community-dwellers aged 65 years and over at baseline; Information regarding CP and analgesics consumption was collected using questionnaires. Dementia was clinically assessed every 2 years. The population was divided into 4 groups according to CP and analgesic drugs intake (CP+/A+, CP+/A-, CP-/A+, CP-/A-). An illness-death model was used to estimate the link between CP and incident dementia risk controlled for sex, educational level, comorbidities, depression, antidepressant drugs and analgesics. RESULTS: Five hundred ninety three participants (364 women) who completed a CP questionnaire, were included. They were followed-up over 24 years (mean follow-up: 11.3 years, SD 7.3). A total of 223 participants (32.5%) had CP, among them 88 (38.6%) took analgesic drugs. Compared to CP-/A- group, CP+/A+ participants had a higher risk of developing dementia in the univariate model (hazard ratio (HR) = 1.73, 95%CI:1.18-2.56; p = 0.0051). However, these results did not persist in the multivariate models (aHR = 1.23, 95%CI:0.88-1.73; p = 0.23). No significant risk for dementia were observed in CP-/A+ and CP+/A- (HR = 1.30, 95%CI:0.84-2.01; p = 0.23 and HR = 1.36, 95%CI:0.95-1.96; p = 0.09, respectively). CONCLUSION: Our results failed to show a significant relationship between the presence of CP and long-term dementia risk, suggesting that the cognitive decline associated with CP observed in the literature does not appear to be related to Alzheimer's disease or related disorders.
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Dolor Crónico , Demencia , Anciano , Dolor Crónico/tratamiento farmacológico , Dolor Crónico/epidemiología , Demencia/epidemiología , Demencia/etiología , Femenino , Humanos , Incidencia , Estudios Longitudinales , Masculino , Estudios Prospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: This study was aimed at evaluating the association between cognitive functioning and the occurrence of behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer's disease (AD). METHODS/DESIGN: The population is derived from the PACO cohort, including 237 patients with prodromal or mild AD. A neuropsychological tests battery exploring verbal and visual memory, language, attention, and executive functions was performed at baseline. BPSD were assessed at 6-, 12-, and 18-month follow-up with neuropsychiatric inventory (NPI). RESULTS: Lower baseline performance on Stroop test interference score was associated with higher subsequent overall NPI scores (P = .006), subscores of anxiety/depression (P = .03), and apathy inventory (P = .01). Conversely, other executive functions, verbal or visual memory, and language performances were not associated with a higher risk of BPSD. CONCLUSION: Our results suggest that poorer inhibition performance would be associated with a higher risk of 18-month BPSD occurrence, including anxiety, depression, and apathy. A better knowledge of the predictive factors of the BPSDs would make it possible to better identify the patients at risk, to propose preventive strategies and an earlier adapted care. J Am Geriatr Soc 68:-, 2020.
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Enfermedad de Alzheimer , Trastornos del Conocimiento , Síntomas Conductuales , Función Ejecutiva , Humanos , Pruebas NeuropsicológicasRESUMEN
BACKGROUND: The identification of factors associated with functional impairment, in particular those which are potentially modifiable, may help to delay the advanced stages of functional dependence in patients with neurocognitive disorders such as Alzheimer's disease and related disorders. The objectives of the MEMORA cohort are to investigate the factors associated, first with functional autonomy change over time, and secondarily with the cognitive performance and behavioral disorders changes over time. METHODS: The MEMORA study is a multicenter prospective cohort study carried out throughout the patient's care pathway, in Memory centers of Lyon (France). The study will include 6780 patients at all stages of memory disorders in 6 years. The follow-up for each patient is planned for 3 years. The main outcome is the functional autonomy level change as assessed by the instrumental abilities of daily living (IADL) score. Patient characteristics include sociodemographic and clinical features, neuropsychological performance, pharmaceutical and non-pharmaceutical therapy. DISCUSSION: This study conducted in a context of routine care may help to identify the factors associated with functional impairment related to progressive neurocognitive disorders. Subsequently, interventions on potentially modifiable factors could be proposed to the patients to improve their management and delay functional dependence. TRIAL REGISTRATION: NCT02302482 , registered 27 November 2014.
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Cognición/fisiología , Trastornos Neurocognitivos/diagnóstico , Trastornos Neurocognitivos/psicología , Pruebas Neuropsicológicas , Actividades Cotidianas/psicología , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Francia/epidemiología , Humanos , Masculino , Trastornos de la Memoria/diagnóstico , Trastornos de la Memoria/epidemiología , Trastornos de la Memoria/psicología , Trastornos Neurocognitivos/epidemiología , Estudios ProspectivosRESUMEN
OBJECTIVE: Aging is associated with a loss of cognitive performance and an increasing occurrence of cardiovascular events. Moreover, cardiovascular risk factors are linked to cognitive impairment and dementia. Whereas individual components of metabolic syndrome (Met S) have been reported to be linked to cognitive decline and dementia, there are very few studies on Met S as a whole. The present study aims to assess the relationship between Met S and its components and cognitive functioning in a cohort of elderly non-demented community residents. DESIGN: Population-based cohort study (PROOF study). Cross-sectional analysis. PARTICIPANTS: Dementia-free community-dwellers aged 65. MEASURES: The PROOF participants underwent an extensive neuropsychological battery at baseline. Summary cognitive measures including memory, attention, and executive performance were created by converting the individual test results to Z scores and computing the average scores within each domain. Each of the three cognitive scores was individually compared between groups as a function of Met S. The cognitive scores and the covariates which were significant in univariate analyses were then included in logistic regression models. RESULTS: A significant association was observed between the presence of metabolic syndrome, poor memory, and executive function even after adjusting for confounding factors (memory: odds ratio: 1.77, p = 0.008; executive functions: odds ratio: 1.91, p = 0.002). CONCLUSIONS: Our study showed that in a sample of elderly community dwellers, Met S was associated with poor memory and executive performance. These results underline the importance of detecting and managing metabolic syndrome components to prevent cognitive impairment and dementia.
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Función Ejecutiva , Trastornos de la Memoria/epidemiología , Síndrome Metabólico/epidemiología , Anciano , HDL-Colesterol/sangre , Estudios Transversales , Femenino , Humanos , Hiperglucemia/complicaciones , Hiperglucemia/epidemiología , Hiperglucemia/psicología , Hipertensión/complicaciones , Hipertensión/epidemiología , Hipertensión/psicología , Hipertrigliceridemia/complicaciones , Hipertrigliceridemia/epidemiología , Hipertrigliceridemia/psicología , Masculino , Trastornos de la Memoria/etiología , Síndrome Metabólico/complicaciones , Síndrome Metabólico/psicología , Pruebas Neuropsicológicas , Factores de RiesgoRESUMEN
BACKGROUND: Alzheimer's disease and related disorders are characterized by cognitive impairment associated with behavioral and psychological symptoms of dementia. These symptoms have significant consequences for both the patient and his family environment. While risk factors for behavioral disorders have been identified in several studies, few studies have focused on the evolution of these disorders. Moreover, it is important to identify factors linked to the long-term evolution of behavioral disorders, as well as patients' and caregivers' quality of life. Our purpose is to present the methodology of the EVITAL study, which primary objective is to determine the factors associated with the evolution of behavioral disorders among patients with Alzheimer's disease and related disorders during the year following their hospitalization in cognitive and behavioral units. Secondary objectives were 1) to assess the factors related to the evolution of behavioral disorders during hospitalization in cognitive and behavioral units; 2) to identify the factors linked to patients' and caregivers' quality of life, as well as caregivers' burden; 3) to assess the factors associated with rehospitalization of the patients for behavioral disorders in the year following their hospitalization in cognitive and behavioral units. METHOD/DESIGN: A multicenter, prospective cohort of patients with Alzheimer's disease and related disorders as well as behavioral disorders who are hospitalized in cognitive and behavioral units. The patients will be included in the study for a period of 24 months and followed-up for 12 months. Socio-demographic and environmental data, behavioral disorders, medications, patients and caregivers quality of life as well as caregivers burden will be assessed throughout hospitalization in cognitive and behavioral units. Follow-up will be performed at months 3, 6 and 12 after hospitalization. Socio-demographic and environmental data, behavioral disorders, medications, patients and caregivers quality of life, unplanned rehospitalization as well as caregivers burden will also be assessed at each follow-up interview. DISCUSSION: The present study should help better identify the factors associated with reduction or stabilization of the behavioral and psychological symptoms of dementia in patients with Alzheimer's disease. It could therefore help clinicians to better manage these symptoms. TRIAL REGISTRATION: Clinical Trials NCT01901263. Registered July 9, 2013.
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Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/psicología , Readmisión del Paciente/estadística & datos numéricos , Calidad de Vida/psicología , Enfermedad de Alzheimer/tratamiento farmacológico , Cuidadores/psicología , Estudios de Cohortes , Costo de Enfermedad , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Francia , Hospitalización , Humanos , Entrevistas como Asunto/métodos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Psicotrópicos/uso terapéutico , Proyectos de Investigación , Factores de RiesgoRESUMEN
BACKGROUND: Alzheimer's disease is characterised by a loss of cognitive function and behavioural problems as set out in the term "Behavioural and Psychological Symptoms of Dementia". These behavioural symptoms have heavy consequences for the patients and their families. A greater understanding of behavioural symptoms risk factors would allow better detection of those patients, a better understanding of crisis situations and better management of these patients. Some retrospective studies or simple observations suggested that personality could play a role in the occurrence of behavioural symptoms. Finally, performance in social cognition like facial recognition and perspective taking could be linked to certain personality traits and the subsequent risks of behavioural symptoms. We propose to clarify this through a prospective, multicentre, multidisciplinary study. Main Objective: -To assess the effect of personality and life events on the risk of developing behavioural symptoms. Secondary Objectives: -To evaluate, at the time of inclusion, the connection between personality and performance in social cognition tests; -To evaluate the correlation between performance in social cognition at inclusion and the risks of occurrence of behavioural symptoms; -To evaluate the correlation between regional cerebral atrophy, using brain Magnetic Resonance Imaging at baseline, and the risk of behavioural symptoms. METHODS/DESIGN: Study type and Population: Prospective multicentre cohort study with 252 patients with Alzheimer's disease at prodromal or mild dementia stage. The inclusion period will be of 18 months and the patients will be followed during 18 months. The initial evaluation will include: a clinical and neuropsychological examination, collection of behavioural symptoms data (Neuropsychiatric-Inventory scale) and their risk factors, a personality study using both a dimensional (personality traits) and categorical approach, an inventory of life events, social cognition tests and an Magnetic Resonance Imaging. Patients will be followed every 6 months (clinical examination and collection of behavioural symptoms data and risk factors) during 18 months. DISCUSSION: This study aims at better identifying the patients with Alzheimer's disease at high risk of developing behavioural symptoms, to anticipate, detect and quickly treat these disorders and so, prevent serious consequences for the patient and his caregivers. TRIAL REGISTRATION: ClincalTrials.gov: NCT01297140.
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Enfermedad de Alzheimer/psicología , Cognición/fisiología , Demencia/psicología , Personalidad , Calidad de Vida/psicología , Anciano , Enfermedad de Alzheimer/diagnóstico , Cuidadores/psicología , Demencia/diagnóstico , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Inventario de Personalidad , Estudios ProspectivosRESUMEN
INTRODUCTION: Adverse childhood events (ACEs) have been linked to widespread chronic pain (CP) in various cross-sectional studies, mainly in clinical populations. However, the independent role of different ACEs on the development of different types of CP remains elusive. Accordingly, we aimed to prospectively assess the associations between specific types of ACEs with the development of multisite CP in a large population-based cohort. METHODS: Data stemmed from the three first follow-up evaluations of CoLaus|PsyCoLaus, a prospective population-based cohort study of initially 6734 participants (age range: 35-75 years). The present sample included 1537 participants with 2161 analyzable intervals (49.7% men, mean age 57.3 years). Diagnostic criteria for ACEs were elicited using semi-structured interviews and CP was assessed by self-rating questionnaires. Multinomial logistic regressions with generalized estimating equations method analyzed the relationship between the different ACEs measured in the beginning of the interval and the risk of developing multisite CP during the follow-up. Sensitivity analyses were performed to assess the predictive value of ACEs on multisite CP with neuropathic features. RESULTS: Participants with a history of parental divorce or separation had an increased risk of developing multisite CP at during follow-up in comparison to those without (RR1.98; 95% CI 1.13-3.47). A strong association was highlighted between parental divorce or separation and the risk of subsequent CP with neuropathic characteristics (RR 4.21, 95% CI 1.45-12.18). CONCLUSION: These results highlight the importance of psychotherapeutic management of people experiencing parental separation to prevent CP in the future.
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Experiencias Adversas de la Infancia , Dolor Crónico , Humanos , Masculino , Femenino , Dolor Crónico/epidemiología , Dolor Crónico/psicología , Persona de Mediana Edad , Adulto , Experiencias Adversas de la Infancia/estadística & datos numéricos , Anciano , Incidencia , Estudios Prospectivos , Adultos Sobrevivientes de Eventos Adversos Infantiles/estadística & datos numéricos , Adultos Sobrevivientes de Eventos Adversos Infantiles/psicología , Factores de RiesgoRESUMEN
BACKGROUND: Only half of those living with Alzheimer's disease in France are currently diagnosed, and only one patient in three is supported during the early stages of dementia. This study aims to evaluate three cognitive tests for their predictive ability to diagnose mild cognitive impairments and Alzheimer's disease and related disorders. For people aged 65 years or over, presenting with a memory complaint, these tests can be performed easily during a preventative consultation. METHOD/DESIGN: The EVATEM (évaluation des troubles de l'équilibre et de la mémoire (evaluation of balance and memory problems)) cohort study was designed to prospectively assess the predictive value of tests for the diagnosis of mild cognitive impairments and Alzheimer's disease in elderly subjects aged 65 years or over. Subjects were recruited from three health examination centers that are part of the French health insurance system. If a memory complaint was identified (using a dedicated questionnaire), the five-word test, the cognitive disorders examination test and the verbal fluency test were administered during a preventative consultation. A memory consultation was performed at a University Hospital to diagnosis any potential cognitive disorder and a one-year follow-up consultation was also scheduled. We recorded 2041 cases of memory complaint at our Health Examination Centers. Cognitive tests were refused by 33.6% of people who had a memory complaint. The number of subjects sent to a University Hospital memory consultation was 832 and 74.5% of them completed this consultation. The study population therefore includes 620 subjects. DISCUSSION: Tests for the early diagnosis of a mild cognitive impairment or Alzheimer's disease and related disorders should be used in centers dedicated to disease prevention. These should guide subjects with memory impairment to full memory consultations at hospitals and improve the access to early medical and behavioral support. TRIAL REGISTRATION: ClinicalTrials.gov:NCT01316562.
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Centros Comunitarios de Salud , Seguro de Salud , Trastornos de la Memoria/diagnóstico , Trastornos de la Memoria/epidemiología , Pruebas Neuropsicológicas , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Diagnóstico Precoz , Femenino , Estudios de Seguimiento , Francia/epidemiología , Humanos , Masculino , Trastornos de la Memoria/psicología , Estudios ProspectivosRESUMEN
ABSTRACT: Chronic pain (CP) is often accompanied by mental disorders (MDs). However, little is known concerning the long-term effect of MDs, personality traits, and early-life traumatic events (ETEs) on CP course. Accordingly, we aimed to prospectively assess the associations of major depressive disorders (MDDs), anxiety disorders, personality traits, and ETEs with the incidence and the persistence of CP in middle-aged and older community dwellers. Data stemmed from the 3 first follow-up evaluations of CoLaus|PsyCoLaus, a prospective cohort conducted in the general population of Lausanne (Switzerland). Diagnostic criteria for MDs and ETEs were elicited using semistructured interviews. CP and personality traits were assessed by self-rating questionnaires. Follow-up intervals were subdivided into 2 groups: those without (n = 2280) and those with (n = 1841) CP initially. The associations between the psychological variables and the occurrence or persistence of CP 5 years later were assessed using serially adjusted logistic regression models. Higher neuroticism (odds ratio [95% confidence interval] 1.21 [1.08; 1.36]) and extraversion (1.18 [1.06; 1.32]) were associated with higher 5-year CP incidence, whereas current (2.14 [1.34; 3.44]) and remitted MDD (1.29 [1.00; 1.66]) as well as lower extraversion (0.83 [0.74; 0.94]) were associated with persistence of CP. By contrast, ETEs and anxiety disorders were not associated with the incidence or persistence of CP. Our results suggest that personality traits are associated with both CP occurrence and persistence, whereas the MDDs may be more associated with CP persistence. Both personality and MDD are accessible to psychotherapy, and MDD is also accessible to pharmacotherapy. Hence, these therapeutic measures might decrease the risk of CP and its persistence.
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Dolor Crónico , Trastorno Depresivo Mayor , Trastornos Mentales , Niño , Persona de Mediana Edad , Humanos , Anciano , Trastorno Depresivo Mayor/epidemiología , Incidencia , Dolor Crónico/epidemiología , Estudios Prospectivos , Trastornos Mentales/diagnóstico , PersonalidadRESUMEN
Introduction: Lower cognitive functioning in old age has been associated with personality traits or systemic inflammatory markers. Associations have also been found between personality traits and inflammatory markers. However, no study has explored the inter-relationships between these three components simultaneously. The present study aims to better understand the inter-relationships among personality traits, inflammatory markers, and cognitive performance in elderly individuals without dementia. Methods: This study utilizes a network analysis approach, a statistical method that allows visualization of the data's unique pairwise associations. We performed a cross-sectional analysis on 720 elderly individuals without dementia, using data from Colaus|PsyColaus, a population-based study conducted in Lausanne, Switzerland. The Revised NEO Five-Factor Inventory (NEO-FFI-R) was used to assess personality traits, and interleukin (IL)-1ß, IL-6, tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) were used as peripheral inflammatory markers. Cognitive domains were investigated using the Mini-Mental State Examination (MMSE), the Verbal Fluency Test, the Stroop Test, the DO40, and the Free and Cued Selective Reminding (FCSR) test. Results: Openness was associated with verbal fluency and Agreeableness with immediate free recall. In contrast, no association between inflammatory markers and personality traits or cognition was identified. Discussion: In elderly individuals without dementia, a high level of Openness or Agreeableness was associated with executive functioning/semantic memory and episodic memory, respectively.
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BACKGROUND: Apathy and depression are two early behavioral symptoms in Alzheimer's disease (AD) and related disorders that often occur prior to the onset of cognitive decline and memory disturbances. Both have been associated with an increased risk of conversion to dementia, with a distinct neuropathology. OBJECTIVE: The assessment of the trajectories of apathy and depression and their independent impact on dementia conversion. METHODS: Apathy and Depression were measured using the Neuropsychiatric Inventory for caregiver (NPI) and clinician (NPI-C), among the nondemented individuals reporting subjective cognitive decline (SCD) at baseline. They were followed up over a 60-month period. Some converted to dementia, according to the methodology carried out by the French Memento Cohort. RESULTS: Among individuals with SCD (nâ=â2,323), the levels of apathy and depression were low and did not evolve significantly over the 60-month period, despite a trend in apathy increasing as of month 24. Regarding SCD individuals who converted to dementia within the 60-month period (nâ=â27), the prevalence of depression remained globally steady, while the levels of apathy increased over time. CONCLUSION: Apathy and depression have different trajectories among individuals with SCD and apathy alone is more likely-compared to depression-to be associated with conversion to dementia.
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Enfermedad de Alzheimer , Apatía , Disfunción Cognitiva , Humanos , Depresión/epidemiología , Depresión/diagnóstico , Pruebas Neuropsicológicas , Disfunción Cognitiva/psicología , Enfermedad de Alzheimer/patologíaRESUMEN
BACKGROUND AND AIMS: Diabetes and impaired fasting glucose, as well as cognitive impairment, are common in the elderly. Although several cross-sectional studies have demonstrated the influence of diabetes on cognitive impairment, only a few longitudinal studies have assessed the relationship between diabetes, impaired fasting glucose and cognitive decline in non-demented elderly community dwellers, by means of extensive neuropsychological batteries. The present study assesses the relationship between baseline diabetes, impaired fasting glucose (IFG) and 2- year evolution of memory, attention and executive performance in a sample of non-demented elderly subjects. DESIGN: Population-based cohort study [(PROgnostic indicator OF cardiovascular and cerebrovascular events (PROOF)]. PARTICIPANTS: One hundred and sixty-three community dwellers aged 65 years without dementia at recruitment. MAIN OUTCOME MEASURES: Memory, attention and executive performance. RESULTS: A significant association was observed between baseline diabetes mellitus and a higher 2-year decline in the Trial Making Test B and Stroop test exploring attention and executive function. This effect remained significant after adjusting for age, gender, education, anxiety and depressive symptoms, as well as other cardiovascular risk factors (F=2.41; p=0.007). Instead, no relationship was observed between IFG and cognitive decline. CONCLUSIONS: Our study showed that, in a sample of elderly non-demented community dwellers, diabetes mellitus (but not IFG) is associated with a higher decline in selective attention and executive functioning. These results emphasize the importance of detecting and man- aging diabetes and impaired fasting glucose, in order to prevent cognitive impairment and dementia.
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Glucemia/metabolismo , Trastornos del Conocimiento/sangre , Complicaciones de la Diabetes/sangre , Diabetes Mellitus/sangre , Diabetes Mellitus/psicología , Ayuno/sangre , Factores de Edad , Anciano , Atención/fisiología , Trastornos del Conocimiento/psicología , Estudios de Cohortes , Complicaciones de la Diabetes/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Memoria/fisiología , Evaluación de Resultado en la Atención de Salud , Factores de RiesgoRESUMEN
BACKGROUND: Facial emotion recognition (FER) and gaze direction (GD) identification are core components of social cognition, possibly impaired in many psychiatric or neurological conditions. Regarding Alzheimer's disease (AD), current knowledge is controversial. OBJECTIVE: The aim of this study was to explore FER and GD identification in mild AD compared to healthy controls. METHODS: 180 participants with mild AD drawn from the PACO study and 74 healthy elderly controls were enrolled. Participants were asked to complete three socio-cognitive tasks: face sex identification, recognition of facial emotions (fear, happiness, anger, disgust) expressed at different intensities, and GD discrimination. Multivariate analyses were conducted to compare AD participants and healthy controls. RESULTS: Sex recognition was preserved. GD determination for subtle deviations was impaired in AD. Recognition of prototypically expressed facial emotions was preserved while recognition of degraded facial emotions was impacted in AD participants compared to controls. Use of multivariate analysis suggested significant alteration of low-expressed fear and disgust recognition in the AD group. CONCLUSION: Our results showed emotion recognition and GD identification in patients with early-stage AD compared to elderly controls. These impairments could be the object of specific therapeutic interventions such as social cognition remediation or raising awareness of primary caregivers to improve the quality of life of patients with early AD.
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Enfermedad de Alzheimer , Reconocimiento Facial , Anciano , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/psicología , Emociones , Expresión Facial , Humanos , Calidad de VidaRESUMEN
Introduction: Lockdown over the Covid-19 pandemic might have had a major impact on people's mental health. The present longitudinal study was aimed to explore the impact of the two first lockdowns on anxious and depressive symptoms of older subjects suffering from psychiatric disorders and to highlight their strategies to cope with the stress induced by these lockdowns. Methods: Twenty-one outpatients from psychogeriatric units benefited from a follow-up visit phone. They filled out questionnaires assessing their anxious (GAD-7) and depressive (Mini-GDS) symptomatology and a questionnaire about their coping strategies (Brief COPE). Results: The depressive symptomatology significantly decreased between the 1st lockdown and the second assessment 9 months later with a GDS score significantly decreasing from 1.7 ± 1.2 to 0.9 ± 1.0. Conversely, anxiety remained stable with a mean GAD-7 score from 6.2 ± 5.1 to 6.3 ± 4.4. Furthermore, coping strategies were correlated with both depressive symptomatology and anxiety. At the same time, coping strategies focused on emotional support, acceptance, selfdistraction, and expression of feeling during the first lockdown had shifted 9 months later towards positive reframing and problem-solving strategies (active coping and planification) with a significant increase of active coping. Conclusion: The study showed that during the Covid-19 pandemic and its lockdown, older subjects with psychiatric disorders were able to engage coping strategies and to mitigate their depressive symptomatology and these coping strategies were flexible according to the context.
Contexte: Le confinement durant la pandémie de Covid-19 a eu un impact majeur sur la santé mentale. Cette étude longitudinale réalisée durant la pandémie avait pour objectif d'évaluer l'impact des deux premiers confinements sur les symptômes anxieux et dépressifs de sujets âgés avec troubles psychiatriques, et de mettre en évidence leurs stratégies d'adaptation pour faire face au stress. Méthodes: Vingt et un patients de psychogériatrie ont bénéficié d'un suivi en téléconsultation. Ils ont renseigné des questionnaires mesurant leur symptomatologie anxieuse (GAD 7) et dépressive (Mini-GDS), et leurs stratégies de coping. Résultats: La symptomatologie dépressive a significativement diminué entre le premier confinement et l'évaluation réalisée neuf mois plus tard (avec respectivement : scores à la Mini-GDS à 1,7 = 1,2 et 0,9 ± 1,0, p = 0,01). En revanche, le niveau d'anxiété ne s'est pas modifié (avec respectivement score GAD7 à 6,2 ± 5,1 et 6,3 ± 6,4, p = 0,4). Par ailleurs, des corrélations significatives entre certaines stratégies de coping, la dépression et l'anxiété ont été observées. Les stratégies de coping centrées sur le soutien émotionnel lors du premier confinement ont évolué vers des stratégies orientées sur la résolution de problème neuf mois plus tard. Ainsi, l'étude a montré que durant cette période de confinement et de pandémie de Covid-19, des sujets âgés ont pu mobiliser des stratégies de coping et atténuer leur symptomatologie dépressive et que ces stratégies ont été modulables selon le contexte.
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Adaptación Psicológica , Ansiedad , COVID-19 , Depresión , Trastornos Mentales , Anciano , Humanos , Ansiedad/epidemiología , Ansiedad/psicología , Control de Enfermedades Transmisibles , COVID-19/psicología , Depresión/epidemiología , Depresión/psicología , Estudios Longitudinales , PandemiasRESUMEN
Background: Due to the lockdown linked to the COVID-19 pandemic, the French National Authority for Health has recommended reinforced follow-up of psychiatric patients, with particular attention to people over 65 years. Cross-sectional studies reported an increased risk of anxiety, depression, and suicide during this period. Older people with psychiatric disorders are at higher risk of developing severe COVID-19 and worsening their psychiatric symptoms. Objective: The main objective is to evaluate the link between coping strategies and the onset of post-traumatic stress disorder (PTSD) after lockdown. The secondary objective is to assess the psychological factors influencing lockdown experiences such as personality, attachment type, or coping strategies. Method/Design: this is a multicenter cohort study including 117 patients followed up by phone in two French geriatric psychiatry units. Sociodemographic variables, psychiatric diagnoses, lockdown conditions, coping strategies, anxiety, and depressive symptoms reported during the first lockdown will be collected retrospectively from the medical file. A first prospective assessment including personality traits, attachment type, and traumatic life events will be conducted at 12 months (T1). Follow-up visits assessing anxious-depressive symptoms and PTSD will be made 18 (T2) and 24 months (T3) after the first lockdown. The primary outcome measure is PTSD symptoms. Secondary outcomes measures are coping strategies, generalized anxiety, anxiety about the COVID-19 pandemic, and quality of life. Discussion: This study aims to determine if the type of coping strategies usually employed have an impact on the onset of PTSD after a lockdown period. It will also determine if these coping strategies are influenced by other factors such as sociodemographic variables, lockdown conditions, particular personality traits, attachment type, and traumatic life events. This study could help identify factors associated with a poorer experience of lockdowns and pandemic crisis in elderly patients followed in a psychiatric center, and guide support in future similar situations. Trial Registration: ClinicalTrials.gov: http://clinicaltrials.gov/show/NCT04760795, Registered 18 February 2021.
RESUMEN
BACKGROUND: Alzheimer's disease (AD) is a neurodegenerative pathology that disrupts processing of facial expressions of emotion. The impairment was demonstrated for negative emotions in tasks of matching, discriminating, and labeling facial expressions but no study has included the expression of pain in its protocol. OBJECTIVE: The objective was to study the processing of emotional facial expressions in AD with a particular interest in pain expression. METHODS: Twenty-seven controls, 15 mild AD patients, and 15 moderate AD patients had to perform four emotional tasks: identification of facial expressions, matching pain expressions, discriminating the intensity of pain expressions, and judging pain intensity. RESULTS: Some emotions were less efficiently recognized by AD patients compared to controls (pâ<â0.001), specifically fear from the mild stage (pâ<â0.05), pain and disgust from the moderate stage (pâ<â0.05 and pâ<â0.001 respectively). The Exploratory Factor Analysis showed that recognition of pain and recognition of other discreet emotions were underpinned by two different latent factors. Performances on pain expression matching task and pain intensity discrimination task did not differ by group. (pâ=â0.334 and pâ=â0.787 respectively). Finally, moderate AD patients judged the pain less intensively than the Control group for both, moderate, and severe pain intensity (pâ<â0.001). CONCLUSION: Our data suggest that AD disrupts the recognition of pain expression along with recognition of fear and disgust. Additionally, AD patients seem to underestimate pain intensity compared to controls. The self-rated pain scales should be adapted to the pain processing deficit of AD patients.
Asunto(s)
Enfermedad de Alzheimer , Expresión Facial , Enfermedad de Alzheimer/psicología , Emociones , Humanos , Dolor , Reconocimiento en PsicologíaRESUMEN
INTRODUCTION: Cross-sectional studies highlighted changes in autonomic nervous system (ANS) activity in geriatric depression. However, few longitudinal studies assessed this link which remains still debated. We examined the longitudinal association between lifetime depression history, current depressive disorders, and the evolution of ANS activity in older community women. METHODS: The present data stemmed from the PROOF study, a population-based cohort of 1011 community-dwellers followed-up at 2-year intervals for 10 years. Only data from female participants was analyzed (n = 508, mean age 68.5 ± 0.88 years), as very few men had depression in our population. Depressive symptoms and depression history were collected at baseline. Participants were classified in four groups according to presence or absence of history of depression (HD) or current depressive symptomatology (CD): HD+/CD+, HD-/CD+, HD+/CD- and HD-/CD-. ANS activity was assessed during the follow-up through 24-h heart rate variability (HRV). Longitudinal associations between depressive status and HRV indices during the follow-up were investigated using multivariate linear mixed models. RESULTS: Compared to HD-/CD- group, women belonging to HD-/CD+ group had greater baseline parasympathetic tone, as measured by lower LF index and LF/HF balance. The longitudinal analysis exhibited a significant enhancement of LF/HF balance with time, measuring an increase of sympathetic tone in HD-/CD+ group. CONCLUSION: Our findings suggest that late-onset depressive symptoms may be associated with subsequent autonomic dysregulation in older women. These results highlight the importance of detecting and managing depressive symptoms to limit their consequences on ANS functioning, and the risk of cardiovascular events.