CCR5 deficiency: Decreased neuronal resilience to oxidative stress and increased risk of vascular dementia.

INTRODUCTION: As the chemokine receptor5 (CCR5) may play a role in ischemia, we studied the links between CCR5 deficiency, the sensitivity of neurons to oxidative stress, and the development of dementia. METHODS: Logistic regression models with CCR5/apolipoprotein E (ApoE) polymorphisms were applied on a sample of 205 cognitively normal individuals and 189 dementia patients from Geneva. The impact of oxidative stress on Ccr5 expression and cell death was assessed in mice neurons. RESULTS: CCR5-Δ32 allele synergized with ApoEε4 as risk factor for dementia and specifically for dementia with a vascular component. We confirmed these results in an independent cohort from Italy (157 cognitively normal and 620 dementia). Carriers of the ApoEε4/CCR5-Δ32 genotype aged ≥80 years have an 11-fold greater risk of vascular-and-mixed dementia. Oxidative stress-induced cell death in Ccr5-/- mice neurons. DISCUSSION: We propose the vulnerability of CCR5-deficient neurons in response to oxidative stress as possible mechanisms contributing to dementia.

[Equality across ages : addressing gender discrimination among older patients]. / Égalité à tous les âges : aborder la discrimination de genre chez les patient-e-s âgé-e-s.

The aim of this article is to draw attention to sex- and gender-related differences in the management of elderly patients. This issue is illustrated with two diseases linked to gender and sex: osteoporosis and high blood pressure. On one hand, patients of the sex less affected by the disease may feel less concerned; on the other hand, these patients are at greater risk of being under-diagnosed by medical and nursing staff. In addition, studies tend to overlook patients of the less-affected sex, resulting in guidelines that do not take account of sex or gender specific characteristics. There is even less literature on gender-related disparities in care in the elderly population than in the young, but it can be assumed that this risk of disparities exists even more in relation to specificities in diagnosis and care of elderly patients.

Cet article vise à attirer l'attention sur le risque de différences de prise en charge des patient-e-s âgé-e-s liées au sexe et au genre, illustré par deux pathologies considérées l'une comme féminine, l'autre comme masculine : l'ostéoporose et l'hypertension artérielle. Dans ce type de pathologies, les patient-e-s du sexe le moins touché par la maladie peuvent se sentir moins concerné-e-s et ont un risque accru de sous-diagnostic de la part du corps médicosoignant. De plus, les études tendent à négliger les patient-e-s du sexe moins touché, aboutissant à des guidelines ne tenant pas compte de spécificités liées au sexe ou au genre. La littérature sur les disparités de prise en charge liées au genre dans la population âgée est encore très limitée. Néanmoins, il est important de prendre en compte les spécificités liées au genre au même titre que celles liées à l'âge avancé.

A novel prosthesis presentation test to screen for cognitive and functional decline.

OBJECTIVES AND BACKGROUND: To validate a novel screening test for cognitive and functional decline in older patients rehabilitated with complete removable dental prostheses (CRDPs). MATERIALS AND METHODS: Edentate old in-patients rehabilitated with CRDPs were included in this study. Participants were requested to remove their prostheses before their intraoral examinations. The prostheses were then presented in an inverted orientation. Participants had to correct the orientation of the prostheses and insert them in the appropriate jaws. The test was repeated after the intraoral exam. Appropriate statistical models were used (⍺ = .05) to associate the test results with the participants' mini-mental state examination (MMSE) score, functional independence measure (FIM), age and sex. RESULTS: Among the 86 participants (mean-age: 85.4 ± 6.4 years; mean MMSE: 19.8 ± 5.5; mean FIM: 77.9 ± 20.8), 21 (24.4%) failed to correctly insert the prosthesis. The prosthesis presentation test (PPT) was associated with the FIM but not the MMSE. Regression models further confirmed an association with age (P = .043), but not sex. Additional analyses revealed the PPT test is associated with the FIM's cognitive sub-sets of memory, problem solving and social interaction. CONCLUSION: The PPT is a novel, simple and quick screening tool that can help detect functional difficulties in older people. It can easily be performed during an oral examination. Future studies are needed to determine whether the PPT can be used to detect deficits in executive function, as a complement to the MMSE and also as a first assessment of a patient's ability to manage dentures independently.

One-year persistent symptoms and functional impairment in SARS-CoV-2 positive and negative individuals.

BACKGROUND: Persistent symptoms of SARS-CoV-2 are prevalent weeks to months following the infection. To date, it is difficult to disentangle the direct from the indirect effects of SARS-CoV-2, including lockdown, social, and economic factors. OBJECTIVE: The study aims to characterize the prevalence of symptoms, functional capacity, and quality of life at 12 months in outpatient symptomatic individuals tested positive for SARS-CoV-2 compared to individuals tested negative. METHODS: From 23 April to 27 July 2021, outpatient symptomatic individuals tested for SARS-CoV-2 at the Geneva University Hospitals were followed up 12 months after their test date. RESULTS: At 12 months, out of the 1447 participants (mean age 45.2 years, 61.2% women), 33.4% reported residual mild to moderate symptoms following SARS-CoV-2 infection compared to 6.5% in the control group. Symptoms included fatigue (16% vs. 3.1%), dyspnea (8.9% vs. 1.1%), headache (9.8% vs. 1.7%), insomnia (8.9% vs. 2.7%), and difficulty concentrating (7.4% vs. 2.5%). When compared to the control group, 30.5% of SARS-CoV-2 positive individuals reported functional impairment at 12 months versus 6.6%. SARS-CoV-2 infection was associated with the persistence of symptoms (adjusted odds ratio [aOR] 4.1; 2.60-6.83) and functional impairment (aOR 3.54; 2.16-5.80) overall, and in subgroups of women, men, individuals younger than 40 years, those between 40-59 years, and in individuals with no past medical or psychiatric history. CONCLUSION: SARS-CoV-2 infection leads to persistent symptoms over several months, including in young healthy individuals, in addition to the pandemic effects, and potentially more than other common respiratory infections. Symptoms impact functional capacity up to 12 months post infection.

Fighting social isolation in times of pandemic COVID-19: the role of video calls for older hospitalized patients.

BACKGROUND: Loneliness and social isolation are associated with anxiety and psychological discomfort, especially amongst the oldest and fragile persons. AIMS: SILVER evaluates the acceptance of video calls by old hospitalized patients and their relatives during the ban on visits due to the COVID-19. Moreover, SILVER evaluates if the use of different communication technology is associated with different outcomes in terms of anxiety, fear of self and of others' death and mood. METHODS: SILVER is an observational multicentre study. Patients hospitalized in two geriatric units in Switzerland and in one orthogeriatric unit in Italy and their relatives were enrolled. Participants can freely choose to use phone or video calls and were evaluated over a week. We measured anxiety, fear of death and mood at baseline and at the end of the study with standard scales. The use of video or phone calls was associated to a change in these parameters by two-way ANOVA for repeated measures. RESULTS: Sixty-four patients and relatives were enrolled, 26.5% used phone calls and 73.5% video calls. The use of video calls was associated with a reduction in anxiety and fear of death in patients and relatives as compared to participants using phone calls. DISCUSSION: Old patients and their relatives accepted and appreciated the use of video calls during hospitalization; moreover, participant using video calls appears to be less anxious and less afraid of death. CONCLUSIONS: Video calls may be a useful communication tool for hospitalized older patients to keep social relationships with relatives and reduce their anxiety and fear of death. TRIAL REGISTRATION: Retrospectively registered on 1st September 2021 in ClinicalTrials.gov (NCT05000099).

[An infectious diseases ward dedicated to elderly patients: why and how?] / Unité d'infectiologie gériatrique : pourquoi et comment ?

The management of infections in the elderly requires medical and nursing expertise with a standardized global geriatric evaluation. We present here an original and pioneering unit in Switzerland, dedicated to polymorbid and complex elderly patients hospitalized for an acute infection and who will benefit from joint management by an interdisciplinary team including a geriatrician, an infectious diseases specialist and a pharmacogeriatrician. The Hôpital des Trois-Chêne, which has geriatric emergencies, intermediate care beds, SOMADEM (somatic dementia) and UGIMP (medico-psychiatric) programs adapted to this population, seems to be the ideal place to host this unit. The teams will benefit from theoretical and practical training associated with field coaching.

La prise en charge des infections de la personne âgée nécessite une expertise médico-soignante avec une évaluation gériatrique globale standardisée. Nous présentons ici une unité originale et pionnière en Suisse, dédiée aux patients âgés polymorbides et complexes hospitalisés pour infection aiguë. Ils bénéficieront d'une prise en charge conjointe par une équipe interdisciplinaire comprenant entre autres le gériatre, l'infectiologue et le pharmacogériatre. L'hôpital des Trois-Chêne, qui possède des urgences gériatriques, des lits de soins intermédiaires, les programmes SOMADEM (somatique démence) et UGIMP (médico-psychiatrique) adaptés à cette population, semble le lieu idéal pour accueillir cette unité. Les équipes bénéficieront d'une formation théorique et pratique associée à du coaching de terrain.

Incidence, characteristics and clinical relevance of acute stroke in old patients hospitalized with COVID-19.

BACKGROUND: Stroke in the course of coronavirus disease (COVID-19) has been shown to be associated with more severe respiratory symptoms and higher mortality, but little knowledge in this regard exists on older populations. We aimed to investigate the incidence, characteristics, and prognosis of acute stroke in geriatric patients hospitalized with COVID-19. METHODS: A monocentric cross-sectional retrospective study of 265 older patients hospitalized with COVID-19 on acute geriatric wards. 11/265 presented a stroke episode during hospitalization. Mortality rates and two-group comparisons (stroke vs non-stroke patients) were calculated and significant variables added in logistic regression models to investigate stroke risk factors. RESULTS: Combined ischemic and hemorrhagic stroke incidence was 4.15%. 72.7% of events occurred during acute care. Strokes presented with altered state of consciousness and/or delirium in 81.8%, followed by a focal neurological deficit in 45.5%. Ischemic stroke was more frequently unilateral (88.8%) and localized in the middle cerebral artery territory (55.5%). Smoking and a history of previous stroke increased by more than seven (OR 7.44; 95% CI 1.75-31.64; p = 0.007) and five times (OR 5.19; 95% CI 1.50-17.92; p = 0.009), respectively, the risk of stroke. Each additional point in body mass index (BMI) reduced the risk of stroke by 14% (OR 0.86; 95% CI 0.74-0.98; p = 0.03). In-hospital mortality (32.1% vs. 27.3%; p > 0.999) and institutionalization at discharge (36.4% vs. 21.1%; p = 0.258) were similar between patients with and without stroke. CONCLUSION: Incident stroke complicating COVID-19 in old patients was associated with active smoking, previous history of stroke, and low BMI. Acute stroke did not influence early mortality or institutionalization rate at discharge.

Validation of the Perform-FES: a new fear of falling scale for hospitalized geriatric patients.

BACKGROUND: Fear of falling is highly prevalent in older adults and associated with numerous negative health events. The main objective of this study was to validate a scale to assess fear of falling, based on performance in real situation (Perform-FES), in a hospitalized geriatric population. METHODS: In this cross-sectional study, 55 patients (mean age: 85.3 years; 58% women) hospitalized in a geriatric hospital in Geneva (Switzerland) were enrolled. The Perform-FES scale was administered to all patients in conjunction with four other fear of falling scales. We determined the floor and ceiling effects, internal consistency, reliability, construct validity, and discriminative power of the Perform-FES scale. RESULTS: The Perform-FES scale did not demonstrate any significant floor or ceiling effect. It had a good internal consistency (Cronbach's alpha = 0.78) and an excellent reliability (intraclass correlation coefficient = 0.94). Regarding convergent validity, good correlations were shown between the score obtained on the Perform-FES scale and those obtained on other fear of falling scales. Also, the Perform-FES scale was able to discriminate patients with severe functional impairments (area under the ROC curve = 0.81) and had significantly better discriminating performance than other fear of falling scales. CONCLUSION: Findings suggest that the Perform-FES scale has good psychometric properties and may be a relevant tool to assess fear of falling in a geriatric hospitalized population. Future research should focus in particular on assessing the sensitivity to change and the predictive value of this scale in longitudinal studies, and its validity in other populations.

[Hypertension and dementia : A complex link]. / Hypertension artérielle et démence : un lien complexe.

High blood pressure and dementia are both frequent age-related diseases. The purpose of this article is to review the treatment of hypertension and his effects on cognition, and to propose key points to improve hypertension's treatment in dementia suffering patients. The management of hypertension in middle-life patients seems to be very important to avoid or decrease the progression of cognitive impairment or dementia. Nevertheless, there is no guidelines regarding blood pressure in patients concerned by dementia. To personalize the treatment, to take other comorbidities into account, and the frequent reevaluation of the medication are keys of an optimal management of hypertension in general and becomes crucial more specific in this population.

L'HTA et la démence sont deux pathologies fréquentes liées à l'âge. Cet article a pour but de faire le point sur le traitement de l'HTA et son effet sur la survenue de la démence et de proposer quelques réflexions pour une meilleure prise en charge de l'hypertension chez les patients atteints de démence. Le traitement de l'HTA à l'âge mûr de la vie semble indispensable pour éviter ou ralentir la survenue de troubles cognitifs et de démence. Néanmoins, il n'existe pas pour l'instant de recommandation concernant les cibles tensionnelles à viser chez les patients atteints de démence. La personnalisation du traitement, la prise en compte des autres comorbidités et la réévaluation fréquente de la médication antihypertensive sont, d'une façon générale, les clés d'une prise en charge optimale et deviennent cruciales plus spécifiquement dans cette population.

[Use of the non-invasive respiratory support in the geriatric intermediate care unit : The Geneva experience]. / Thérapies respiratoires non invasives aux soins intermédiaires à orientation gériatrique - L'expérience genevoise.

Non-invasive respiratory therapy makes it possible to limit the use of invasive ventilation in certain situations. It can be applied to elderly patients and is effective, including outside intensive care units. The geriatric intermediate care structure at Trois-Chêne Hospital in Geneva is a certified intermediate care unit with a special focus on the care of older patients. This article describes the specificities and challenges of such a unit through its experience with the use of non-invasive respiratory therapy during the Covid-19 pandemic.

Les thérapies respiratoires non invasives permettent de limiter le recours à la ventilation invasive dans certaines indications. Leur application et leur efficacité chez le sujet âgé ont été démontrées, y compris en dehors des unités de soins intensifs. L'unité des soins intermédiaires de l'Hôpital des Trois-Chêne à Genève est une unité accréditée dont la spécificité est une orientation gériatrique. Cet article relate les spécificités et les enjeux d'une telle unité, à partir du retour d'expérience de l'utilisation des thérapies respiratoires non invasives pendant la pandémie Covid-19.

[COGERIA: coordination of care for the frail elderly]. / COGERIA : Coordination des soins de la personne âgée fragile.

COGERIA, a cantonal program is the fruit of a close collaboration between the Geneva General Directorate of Health and the major health and social partners in the canton. The program aims to improve inter-professional care for the frail elderly and to adapt their care pathways in close collaboration with their primary care physicians and home healthcare providers. Launched in May 2019, the program includes more than 283 beneficiaries and 152 primary care physicians in collaboration with the home healthcare providers in the Servette and Meyrin areas. Preliminary results show a possible trend towards a decrease in hospitalizations, as well as major satisfaction from beneficiaries and the COGERIA partners.

La Coordination des soins de la personne âgée fragile est un dispositif cantonal né d'une étroite collaboration entre la Direction générale de la santé et les grands partenaires de la santé et du social à Genève. Ce dispositif œuvre à améliorer la prise en charge interprofessionnelle autour des personnes âgées fragiles et à adapter leurs parcours de soins, en étroite collaboration avec les médecins traitants et les prestataires de soins à domicile. Lancé en mai 2019, le dispositif compte plus de 283 personnes incluses, avec 152 médecins traitants du réseau primaire en collaboration avec l'Institution genevoise de maintien à domicile, ainsi qu'une ouverture récente à tous les prestataires de soins dans les zones de la Servette et de Meyrin. Des résultats préliminaires mettent en évidence une possible tendance à une baisse d'hospitalisations ainsi qu'une grande satisfaction de la part des bénéficiaires et des partenaires.

The A/T/N model applied through imaging biomarkers in a memory clinic.

PURPOSE: The A/T/N model is a research framework proposed to investigate Alzheimer's disease (AD) pathological bases (i.e., amyloidosis A, neurofibrillary tangles T, and neurodegeneration N). The application of this system on clinical populations is still limited. The aim of the study is to evaluate the topography of T distribution by 18F-flortaucipir PET in relation to A and N and to describe the A/T/N status through imaging biomarkers in memory clinic patients. METHODS: Eighty-one patients with subjective and objective cognitive impairment were classified as A+/A- and N+/N- through amyloid PET and structural MRI. Tau deposition was compared across A/N subgroups at voxel level. T status was defined through a global cut point based on A/N subgroups and subjects were categorized following the A/T/N model. RESULTS: A+N+ and A+N- subgroups showed higher tau burden compared to A-N- group, with A+N- showing significant deposition limited to the medial and lateral temporal regions. Global cut point discriminated A+N+ and A+N- from A-N- subjects. On A/T/N classification, 23% of patients showed a negative biomarker profile, 58% fell within the Alzheimer's continuum, and 19% of the sample was characterized by non-AD pathologic change. CONCLUSION: Medial and lateral temporal regions represent a site of significant tau accumulation in A+ subjects and possibly a useful marker of early clinical changes. This is the first study in which the A/T/N model is applied using 18F-flortaucipir PET in a memory clinic population. The majority of patients showed a profile consistent with the Alzheimer's continuum, while a minor percentage showed a profile suggestive of possible other neurodegenerative diseases. These results support the applicability of the A/T/N model in clinical practice.

[Issues and challenges related to COVID-19 in acute geriatric care: lessons learned from the Geneva experience]. / Enjeux et défis du Covid-19 en gériatrie aiguë: leçons tirées de l'expérience genevoise.

The older patients have been the most affected by the SARS-CoV-2 pandemic. In addition, this infection has been responsible for high mortality rate in this population. In this article we wanted to describe the clinical findings we encountered in older people with COVID-19 and share some of the issues and challenges we faced during the COVID-19 pandemic.

Les personnes âgées ont été les plus touchées par la pandémie de SARS-CoV-2. De plus, cette infection a été responsable d'une mortalité élevée au sein de cette population. Dans cet article, nous avons souhaité décrire les particularités cliniques du Covid-19 que nous avons constatées chez les patients âgés et faire part de plusieurs enjeux et défis auxquels nous avons été confrontés au cours de la pandémie de Covid-19.

Prevalence of oral hygiene tools amongst hospitalised elders: A cross-sectional survey.

OBJECTIVE: This study aimed to evaluate the prevalence of various oral hygiene tools amongst hospitalised elders and to associate their cognitive status with the prevalence of tools and oral hygiene status. MATERIALS AND METHOD: Elderly hospitalised participants were included in the study and underwent a brief clinical intra-oral examination. A semi-structured questionnaire evaluated the awareness and personal possession of the various oral hygiene tools. Participants' personal information and various clinical parameters including DMF (T) index, plaque index, CPITN index, denture plaque and calculus index were collected. Mini-Mental State Examination (MMSE) scores were retrieved from the medical records. Linear regression models were applied for statistical analyses (P < 0.05). RESULTS: A total of 100 hospitalised elders (age = 84.5 ± 6.9 years; ♀ = 72, age = 84.9 ± 7.2 years; ♂ = 28, age = 83.3 ± 5.8 years) participated in this study. Awareness was high for manual toothbrush (100%), electric toothbrush (86%), dental floss (79%), interdental brush (44%), interdental stick (55%) and mouthwash (75%), but was low for tongue scraper (9%), while the prevalence of use was 93%, 17%, 27%, 21%, 29%, 39% and 4%, respectively. Linear regression models revealed plaque scores were lower when more hygiene tools were used by the participants (P = 0.0059). Participants with high MMSE scores had lower plaque scores (P = 0.0004) and possessed more oral hygiene tools (P = 0.0203). CONCLUSION: Poor oral hygiene is often noticed in institutionalised elders and might be related to a lack of knowledge about existing oral hygiene tools. These may help optimising oral hygiene, especially in cognitively impaired elders. Oral hygiene tools should be prescribed according to the patient's need, functional and cognitive status.

Frailty and Associated Factors among Centenarians in the 5-COOP Countries.

BACKGROUND: The global number of centenarians is still strongly growing and information about the health and healthcare needs of this segment of the population is needed. This study aimed to estimate the prevalence of frailty among centenarians included in a multinational study and to investigate associated factors. METHODS: The 5-COOP study is a cross-sectional survey including 1,253 centenarians in 5 countries (Japan, France, Switzerland, Denmark, and Sweden). Data were collected using a standardized questionnaire during a face-to-face interview (73.3%), telephone interview (14.5%), or by postal questionnaire (12.2%). The 5 dimensions of the frailty phenotype (weight loss, fatigue, weakness, slow walking speed, and low level of physical activity) were assessed by using self-reported data. Factors associated with frailty criteria were investigated by using multivariate regression models. RESULTS: Almost 95% of the participants had at least 1 frailty criterion. The overall prevalence of frailty (3 criteria or more) was 64.7% (from 51.5% in Sweden to 77.6% in Switzerland), and 32.2% of the participants had 4 or 5 criteria. The most frequent criteria were weakness (84.2%), slow walking speed (77.6%), and low level of physical activity (72.5%), followed by fatigue (43.8%) and weight loss (23.8%). Factors associated with frailty included data collection modes, country of residence, gender, living in institution, depression, dementia, disability, falls, and sensory impairments. CONCLUSIONS: This study shows that reaching 100 years of age rarely goes without frailty and sheds light on factors associated with frailty at a very old age.

[Video games and smartphones : what impacts on cognitive capacities ?] / Jeux vidéo et smartphones : quels impacts sur les capacités cognitives ?

Age-related changes in mental health are an important concern in today's world. Researchers have investigated the effects of video games on mental health for the past 30 years but research on the cognitive impact of smartphones is just beginning. Studies have shown contradictory results and need to be interpreted with caution. Users should be made aware of current knowledge on their potential risks and benefits, without demonizing these relatively new technologies. They should learn how to take advantage of the great potential of these modern devices (they can for example enhance curiosity, sense of purpose and creativity) without becoming enslaved by them.

La santé mentale dans le vieillissement est une source importante d'appréhension dans le monde d'aujourd'hui. Tandis que la recherche sur les effets des jeux vidéo sur la santé mentale est menée depuis une trentaine d'années, celle portant sur les smartphones est balbutiante. Bien qu'ils fassent souvent l'actualité, les résultats des études sont discordants et sont à considérer avec prudence. Sans diaboliser ces technologies, notre tâche est aussi de sensibiliser la population aux potentielles dérives. Nous devons apprendre à nous en servir pour exploiter les innombrables possibilités sans en devenir esclave (par exemple, ces nouvelles technologies peuvent être source de capacités utiles telles que la créativité, la curiosité, la persévérance dans la réalisation d'un objectif).

The impact of automated hippocampal volumetry on diagnostic confidence in patients with suspected Alzheimer's disease: A European Alzheimer's Disease Consortium study.

INTRODUCTION: Hippocampal volume is a core biomarker of Alzheimer's disease (AD). However, its contribution over the standard diagnostic workup is unclear. METHODS: Three hundred fifty-six patients, under clinical evaluation for cognitive impairment, with suspected AD and Mini-Mental State Examination ≥20, were recruited across 17 European memory clinics. After the traditional diagnostic workup, diagnostic confidence of AD pathology (DCAD) was estimated by the physicians in charge. The latter were provided with the results of automated hippocampal volumetry in standardized format and DCAD was reassessed. RESULTS: An increment of one interquartile range in hippocampal volume was associated with a mean change of DCAD of -8.0% (95% credible interval: [-11.5, -5.0]). Automated hippocampal volumetry showed a statistically significant impact on DCAD beyond the contributions of neuropsychology, 18F-fluorodeoxyglucose positron emission tomography/single-photon emission computed tomography, and cerebrospinal fluid markers (-8.5, CrI: [-11.5, -5.6]; -14.1, CrI: [-19.3, -8.8]; -10.6, CrI: [-14.6, -6.1], respectively). DISCUSSION: There is a measurable effect of hippocampal volume on DCAD even when used on top of the traditional diagnostic workup.

[Management of co-morbidities in demented patients]. / Prise en charge des comorbidités chez les patients déments.

The interaction between co-morbidities and dementia is complex. Are co-morbidities dementia or age-related ? Does one die of dementia or with dementia ? Presentation of illness is atypical in older populations but particularly so in individuals with dementia. How should one then detect and measure the co-morbidity burden, what is the best management and the most ethically correct approach to decision making ? We will discuss basic principles that can be applied to ensure optimal care of co-morbidities in people with dementia with some practical examples.

L'interaction entre les comorbidités et la démence est complexe. L'identification des comorbidités chez la personne âgée peut être difficile par une symptomatologie fruste et souvent atypique mais d'autant plus chez les patients atteints de démence. Comment devrait-on alors détecter et mesurer le fardeau d'une comorbidité ? Quelle est l'approche la plus éthiquement correcte dans le processus décisionnel ? Cet article discute des principes de base qui peuvent être appliqués pour assurer la prise en charge optimale des comorbidités chez les personnes atteintes de démence en donnant quelques exemples pratiques.