[Gradual approach for the etiological diagnosis of the neurocognitive disorder]. / Approche graduelle pour le diagnostic étiologique des troubles neurocognitifs.

Neurocognitive disorders (TNC) are of a public health concern. An early and accurate diagnosis is important to tailor a personalised care. We illustrate the importance of a graduated etiological diagnostic approach centered on the clinical presentation employing the case of a patient with a progressive neurovisual disorder suggestive of a common form of Alzheimer's disease. The results of the CSF biomarkers analysis argue against this diagnosis and justifies seeking a Lewy body disease as a differential diagnosis even if all the clinical criteria are initially incomplete. In this article, we illustrate the progressive and graduated approach in the use of complementary medical tests available for reliable and early diagnosis in order to optimise the care plan and predict clinical progress and needs.

Les troubles neurocognitifs (TNC) sont un enjeu de santé publique. Un diagnostic précoce et précis est important pour une prise en charge personnalisée. Nous illustrons l'intérêt d'une démarche diagnostique étiologique graduelle centrée sur la clinique à partir du cas d'un patient atteint d'un trouble neurovisuel progressif suggérant une forme commune de maladie d'Alzheimer. L'analyse des biomarqueurs du LCR argumente en défaveur de ce diagnostic et justifie de rechercher comme diagnostic différentiel une maladie à corps de Lewy même si l'ensemble des critères cliniques sont initialement incomplets. Nous discutons dans cet article la démarche progressive et graduelle dans l'emploi des examens complémentaires à disposition pour un diagnostic fiable et précoce afin d'optimiser le plan de soins et de prédire l'évolution clinique et les besoins.

[Dementia: management and prevention]. / Prise en charge et prévention des pathologies démentielles.

Dementia represents a great challenge for health care providers. Detection of cognitive impairment is critical for early diagnosis of dementia. Early diagnosis allows to initiate individualized management that focuses on maintaining patient's autonomy and supporting their caregivers. Proposed multimodal interventions include physical activity, cognitive training, mediterranean diet, and management of cardiovascular risk factors. Before the initiation of pro-cognitive therapy, medication review is essential to evaluate current treament and determine specific therapeutic objectives, based on patient's overall health and preferences. Overall risk reduction for dementia revolves around similar measures that target physical activity, cognition, diet and management of cardiovascular risk factors.

Factors associated with latent tuberculosis among asylum seekers in Switzerland: a cross-sectional study in Vaud County.

BACKGROUND: Screening and treatment of latent tuberculosis infection (LTBI) in asylum seekers (AS) may prevent future cases of tuberculosis. As the screening with Interferon Gamma Release Assay (IGRA) is costly, the objective of this study was to assess which factors were associated with LTBI and to define a score allowing the selection of AS with the highest risk of LTBI. METHODS: In across-sectional study, AS seekers recently arrived in Vaud County, after screening for tuberculosis at the border were offered screening for LTBI with T-SPOT.TB and questionnaire on potentially risk factors. The factors associated with LTBI were analyzed by univariate and multivariate regression. RESULTS: Among 393 adult AS, 98 (24.93%) had a positive IGRA response, five of them with active tuberculosis previously undetected. Six factors associated with LTBI were identified in multivariate analysis: origin, travel conditions, marital status, cough, age and prior TB exposure. Their combination leads to a robust LTBI predictive score. CONCLUSIONS: The prevalence of LTBI and active tuberculosis in AS is high. A predictive score integrating six factors could identify the asylum seekers with the highest risk for LTBI.

High rate of completion of preventive therapy for latent tuberculosis infection among asylum seekers in a Swiss Canton.

BACKGROUND: Preventive treatment may avoid future cases of tuberculosis among asylum seekers. The effectiveness of preventive treatment depends in large part on treatment completion. METHODS: In a prospective cohort study, asylum seekers of two of the Swiss Canton Vaud migration centres were screened with the Interferon Gamma Release Assay (IGRA). Those with a positive IGRA were referred for medical examination. Individuals with active or past tuberculosis were excluded. Preventive treatment was offered to all participants with positive IGRA but without active tuberculosis. The adherence was assessed during monthly follow-up. RESULTS: From a population of 393 adult migrants, 98 (24.9%) had a positive IGRA. Eleven did not attend the initial medical assessment. Of the 87 examined, eight presented with pulmonary disease (five of them received a full course of antituberculous therapy), two had a history of prior tuberculosis treatment and two had contraindications to treatment. Preventive treatment was offered to 75 individuals (4 months rifampicin in 74 and 9 months isoniazid in one), of whom 60 (80%) completed the treatment. CONCLUSIONS: The vulnerability and the volatility of this population make screening and observance of treatment difficult. It seems possible to obtain a high rate of completion using a short course of treatment in a closely monitored population living in stable housing conditions.