IANA (International Academy on Nutrition and Aging) Expert Group: weight loss and Alzheimer's disease.

Weight loss, together with psychological and behavioural symptoms and problems of mobility, is one of the principal manifestations of Alzheimer's disease (AD). Weight loss may be associated with protein and energy malnutrition leading to severe complications (alteration of the immune system, muscular atrophy, loss of independence). Various explanations have been proposed such as atrophy of the mesial temporal cortex, biological disturbances, or feeding behaviours; however, none has been proven. Prevention of weight loss in AD is a major issue. It requires regular follow-up and must be an integral part of the care plan. The aim of this article is to review the present state of scientific knowledge on weight loss associated with AD. We will consider four points: the natural history of weight loss, its known etiological factors, its consequences and the various management options.

[The clinical impact of treatment discrepancies recorded for 200 patients in an acute geriatric unit]. / Impact clinique des divergences de traitement constatées chez 200 patients conciliés dans un service de gériatrie aiguë.

INTRODUCTION: Medication reconciliation is a process used to identify and prevent medication errors at care transition points in hospitals. The present study's main objectives were to quantify the frequency of inadvertent discrepancies (IDs) per patient and estimate the seriousness of the IDs' clinical impact. PATIENTS AND METHODS: This was a prospective, single-center study performed in a 38-bed acute geriatric unit. All patients hospitalized over a 70-day period were included in the study. RESULTS: Over a 70-day period, 200 patients were included (mean±SD age: 85.5±5.9). A total of 316 IDs were recorded in 117 patients (58.5%, i.e. 1.58 per patient). One third of the IDs were considered to be serious or even life-threatening. Omission was the most common type of ID (58%). Cardiovascular drugs were most frequently involved in IDs (33%). CONCLUSION: We observed an average of more than one ID per patient, when comparing drug treatment at home and drug treatment upon admission to hospital. A third of these IDs may be clinically significant. Geriatric populations with polypharmacy and multiple comorbidities are particularly sensitive to this type of error. Medication reconciliation can detect and correct IDs. Collaboration between physicians and pharmacists will improve the quality of patient care and reduce the iatrogenic risk.

[Consensus statement on severe dementia]. / Consensus sur la démence de type Alzheimer au stade sévère.

Under the auspices of the French Society of Gerontology and Geriatrics, a multidisciplinary team including geriatritians, neurologists, epidemiologists, psychiatrists, pharmacologists and public health specialists developed a consensus on care for patients with severe dementia. They defined 21 recommendations for general practitioners, long-term care physicians and specialists based on knowledge available in 2005. At all stages of the disease, the objective of care is to improve as much as possible quality-of-life for the patient and his/her family, including a life project until the end of life. It is always possible to do something for these patients and their family: nutritional status, behavior disorders, and incapacities to deal with basic activities of daily life have to be taken in consideration. Resource allocation and proximity care have to be targeted. Research areas necessary to improve the care of patients with severe dementia has been selected.

[Consensus statement on severe dementia]. / Consensus sur la démence de type Alzheimer au stade sévère.

Under the auspices of the French Society of Gerontology and Geriatrics, a multidisciplinary group of experts, including geriatricians, neurologists, epidemiologists, psychiatrists, pharmacologists, and public health specialists developed consensus recommendations about care for patients with severe dementia. They defined 21 recommendations for general practitioners, long-term care physicians, and specialists, based on the knowledge currently available (2005). The aim of care at all stages is to mitigate the quality-of-life of patient, caregiver, and family insofar as possible, combining care and future planning until the end of life. Management, to take into account problems including nutritional status, behavior disorders, and ability (or inability) to perform activities of daily living, must be global, multidisciplinary, and coordinated and must optimize use of local medical and social resources. The group also stressed the importance of clinical research to improve knowledge of disease course and assess management strategies and recommended specific area for research.

Segregation analysis and variance components analysis of bone mineral density in healthy families.

Bone mineral density (BMD) was measured in 1992-93 in 129 nuclear families, including 258 parents and 183 children, and was analyzed for familial resemblance factors. BMD measurements were adjusted on weight and age. Segregation analysis rejected the monogenic hypothesis and exhibited a strong polygenic component. Variance components analysis was then used to estimate the parameters of a multivariate normal model including an additive polygenic component, a common environment factor, and a residual specific to each individual. The genetic component was independent of sex and age. The common environmental factor was not significant. The variance of the residual specific factor appeared to be a quadratic function of age, reaching its minimum value at 26.4 years. Consequently, the maximum value for heritability (ratio of genetic variance to total variance) is observed at this age (h2 = 0.84). According to this model, the correlation between two relatives is a function of the ages of each individual in the pair.

Differential influence of physical activity on lumbar spine and femoral neck bone mineral density in the elderly population.

This study investigates the relationship between lifetime physical activity and bone mineral density (BMD) at various sites in 129 healthy men and women aged 72.1 +/- 6.5 years. BMD was measured by dual energy x-ray absorptiometry, and physical activity was assessed by using the QUANTAP system (Quantification de l'Activité Physique), a standardized and structured computer-assisted interview tool designed to assess lifetime physical activity. Linear regression models controlling for age, gender, height, body mass, lean mass, and smoking habits were performed. Higher levels of sporting activity during youth were associated with greater lumbar spine BMD ( p < .001). Similarly, femoral neck BMD was greatest in subjects who reported regularly taking part in sports over the previous 20 years ( p <. 05) and during their whole lifetime ( p < 0.05). Sporting activity at the time of bone mass development increases subsequent lumbar spine BMD, and more recent sporting activity contributes to the preservation of femoral neck BMD. These results suggest that physical activity has a differential influence on BMD at different sites and at different ages, possibly related to the processes of bone construction and bone aging taking place at the time.

Phosphorus magnetic resonance spectroscopy: a noninvasive technique for the study of occlusive arterial leg disease and peripheral vasodilator therapy.

Using 31P nuclear magnetic resonance spectroscopy of the calf muscle, the authors studied patients with peripheral arterial occlusive disease. They studied PCr depletion and intracellular pH during aerobic exercise in patients and controls. The phosphocreatine (PCr) index ([PCr]/([PCr] + [Pi])) at rest was correlated with blood flow measured by plethysmography. During aerobic exercise a greater decrease in pH was obtained in patients (p < 0.03). They also studied the work necessary to reach a PCr index = 0.5 during ischemic exercise. This workload was lower in patients than in controls: 32.99 +/- 3.04 J vs 58.89 +/- 8.55 J, p < 0.05. After vasodilator therapy the workload was improved in patients: 32.99 +/- 3.04 J vs 38.85 +/- 3.54 J, p < 0.05. These results suggest that therapy resulted in improved tissue perfusion in patients.

[Focus on a quick reading of nailfold capillaroscopy]. / Mise au point d'une lecture accélérée de la capillaroscopie peri-unguéale.

The diagnostic value of nailfold capillaroscopy was assessed through blind analysis of a continuous series of 307 examinations and a method for quick reading of nailfold capillaroscopy was elaborated with discriminant analysis. The best criteria for predicting the existence of a systemic disease were: major dystrophies (megacapillary, neocapillary and regressive capillary), minor dystrophies and capillary bed abnormalities, especially in patients presenting with vascular disorders of the upper extremities. Capillaroscopic stages and existence of systemic disease were significantly correlated. Discriminant analysis could globally predict the existence of a systemic disease with age and 4 criteria. In subjects with vascular disorders of the upper extremities it needed only age and 3 criterias (abnormal coloration, major dystrophy presence and percentile of minor dystrophies greater than 15%) but without higher diagnostic value (94.2% of patients with systemic disease and 65.6% of patients without systemic disease were correctly classified). Discriminant analysis allows quick reading of nailfold capilloroscopy in the first examination of patients with vascular disorders of the upper extremities.

[Heparin-induced thrombocytopenia and vena cava filter. Difficulties of treatment]. / Thrombopénie à l'héparine et filtre cave. Difficultés du traitement.

The authors report two cases of thrombosis occurring after partial interruption of the inferior vena cava. They presented as collapse and anuria with fatal outcome. Heparin induced thrombocytopenia was present in two cases and distal migration of filter in one case. Thrombo-embolic complications can follow heparin induced thrombocytopenia and justify first treatment with low molecular weight heparin and/or early treatment with oral anti-coagulant. Thrombosis, recurrent embolism or thrombosis of renal vena may occur after vena cava filter. Renal vena thrombosis especially follow filter movement and present as collapse and cardiac failure often with fatal outcome.

[Abnormalities of the muscular bioenergetics in Steinert's disease]. / Anomalies de la bioénergétique musculaire dans une maladie de Steinert.

The thenar muscles and gastrocnemius of a patient with myotonic dystrophy were investigated, at rest, by phosphorus nuclear magnetic resonance spectroscopy. A decrease in phosphocreatine level and an increase in inorganic phosphate and phosphodiester levels were found in the gastrocnemius, which was clinically spared, whilst the thenar muscles, which were wasted and affected by myotonia, exhibited only an increased inorganic phosphate level and an elevated pH. These findings were comparable with those found in other muscular disorders, such as Duchenne's and Becker's dystrophies, as well as in limb girdle dystrophy. They suggested that the abnormalities observed were unrelated to myotonia or wasting, and the possibility of a secondary mitochondrial disorder in myotonic dystrophy, is to be considered.

[Nailbed capillaroscopy in Crohn's disease]. / Capillaroscopie au lit de l'ongle dans la maladie de Crohn.

It has recently been suggested that chronic mesenteric vasculitis was a pathogenetic mechanism in Crohn's disease. We have performed a prospective nailfold capillaroscopy study in seven patients with acute Crohn's disease. Minor nailbed abnormalities were frequently observed and three patients presented with major capillary dystrophy. These features are similar to those observed in some systemic vasculitis.

[Modalities of detection of abnormal blood level of thyroid hormones in hospitalized aged patients]. / Modalités du dépistage des dyshormonémies thyroïdiennes chez le sujet âgé hospitalisé.

In a continuous series of 3836 patients over 60 years old, 24.1% have abnormal tests, 1.28% present hyperthyroidism and 1.98% hypothyroidism. Screening with TSH alone and T4 if abnormality, appears as the most helpful and costless method in order to detect thyroid dysfunction in hospitalised elderly patients.

[Nutritional and trace elements status in cardiomyopathies in the elderly]. / Statut nutritionnel et en oligo-éléments dans les cardiomyopathies du sujet âgé.

Nutritionnal status remain poor in hospitalized elderly for cardiopathy compared to healthy controls, secondary to bad general status. Selenium rate appears significantly lower in ischemic cardiomyopathy than in valvular or hypertension cardiopathy.

[Herpetic meningoencephalitis in the elderly. Apropos of 13 cases]. / Méningoencéphalite herpétique du sujet âgé. A propos de 13 observations.

In a retrospective analysis of 13 cases of Herpes simplex encephalitis (mean age: 67.2 +/- 6.4 years; ten women, three men), the authors conclude that this infection is more often due to Herpes simplex virus 1 in the elderly. Diagnosis is difficult at an early stage, and must be suspected in case of confusion (9/13), especially feverish (11/13), associated with neurological signs (10/13), and particularly epilepsy (5/13). It requires a lumbar puncture which collect a clear and lymphocytic fluid. Prognosis of this encephalitis depends on early diagnosis and an presumptive therapy with acyclovir. EEG is helpful showing periodic activity (10/13). CT scan and MRI can show unspecific abnormalities, but often too late. Laboratory findings will secondarily confirm the diagnosis quite frequently, using new Elisa methods. Polymerase chain reaction allows earlier diagnosis. Geriatric cases seem more often due to reinfection or to endogen virus reactivation rather than to primary infection.

[Central pontine myelinolysis: apropos of an oligosymptomatic form]. / Myélinolyse centropontine: à propos d'une forme paucisymptomatique.

The authors report a case of paucisymptomatic central pontine myelinolysis (CMP). A 66 years old female had severe hypochloronatremia and hypokaliemia due to diuretic. Despite a slow hydroelectrolytic correction, she presented with dumbness and seizure. CT scan showed hypodensity of protuberance and magnetic resonance imaging (MRI) shown hypersignal of protuberance and undercortex, compatible with central and extra pontine myelinolysis. The long term clinical outcome was good, as MRI's data. Rapid and important correction of severe hyponatremia should be the most important factors of demyelination, secondary to interference with cerebral adaptation mechanisms to hypoosmolality. These factors were not present in this case.

[Value of calculation of the kappa coefficient in the evaluation of an imaging method]. / Intérêt du calcul du coefficient kappa dans l'évaluation d'une méthode d'imagerie.

Radiologists are often confronted to the choice of the most appropriate statistic tool for evaluating diagnostic imaging methods. Using a radiological literature example, the Kappa agreement test is herein described and its applications are determined. Although widely performed to determine the inter-rater agreement, this test is also suited for the confrontation of two or more diagnostic imaging methods applied on the same subjects and providing categorical data. It procures the degree of agreement between the different methods.

[Peri-ungual capillaroscopy. Value in the diagnosis of systemic diseases]. / Capillaroscopie péri-unguéale. Intérêt dans le diagnostic des maladies systémiques.

The diagnostic value of nailfold capillaroscopy was assessed through blind analysis of a continuous series of 354 examinations. Major and minor dystrophies and capillary bed abnormalities are the best criteria, especially in patients presenting with vascular disorders of the upper extremities. A systemic disease (specificity: 82.7 percent; negative predictive value (NPV): 90.2 percent) and specifically a systemic scleroderma (sensitivity: 97.1 percent and NPV: 99.4 percent) is improbable in case of normal capillaroscopy. First component analysis distinguished patients with definite systemic disease from normal subjects. Its value is dubious in other connective tissue diseases systemic lupus erythematosus, rheumatoid arthritis, Sjögren's disease, etc.).