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1.
J Stroke Cerebrovasc Dis ; 26(2): 246-251, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27894887

RESUMO

BACKGROUND: Orthostatic hypotension (OH) is highly prevalent in the elderly, and this population can be exposed to serious complications, including falls and cognitive disorders, as well as overall mortality. However, the pathophysiology of OH is still poorly understood, and innovative methods of cerebral blood flow (CBF) assessment have been required to accurately investigate cerebrovascular reactivity in OH. OBJECTIVES: We want to compare brain tissue pulsatility (BTP) changes during an orthostatic challenge in elderly patients over 80 with and without OH. MATERIALS AND METHODS: Forty-two subjects aged 80 and over were recruited from the geriatric unit of the Hospital of Tours, France, and were divided into two groups according to the result of an orthostatic challenge. The noninclusion criteria were any general unstable medical condition incompatible with orthostatic challenge, having no temporal acoustic window, severe cognitive impairment (Mini Mental Status Examination <15), history of stroke, and legal guardianship. We used the novel and highly sensitive ultrasound technique of tissue pulsatility imaging to measure BTP changes in elderly patients with (n = 22) and without OH (n = 17) during an orthostatic challenge. RESULTS: We found that the mean brain tissue pulsatility related to global intracranial pulsatility, but not maximum brain tissue pulsatility related to large arteries pulsatility, decreased significantly in OH patients, with a delay compared with the immediate drop in peripheral blood pressure. CONCLUSION: Global pulsatile CBF changes and small vessels pulsatility, rather than changes in only large arteries, may be key mechanisms in OH to account for the links between OH and cerebrovascular disorders.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Ecoencefalografia , Hipotensão Ortostática/diagnóstico por imagem , Hipotensão Ortostática/fisiopatologia , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial , Encéfalo/irrigação sanguínea , Circulação Cerebrovascular/fisiologia , Feminino , Humanos , Masculino , Entrevista Psiquiátrica Padronizada , Postura/fisiologia
2.
Br J Nutr ; 113(10): 1628-37, 2015 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-25864611

RESUMO

25-Hydroxyvitamin D (25(OH)D) insufficiency is very common in many countries. Yet, the extent to which 25(OH)D status affects cognitive performance remains unclear. The objective of the present study was to evaluate the cross-time association between midlife plasma 25(OH)D concentrations and subsequent cognitive performance, using a subsample from the French 'SUpplémentation en Vitamines et Minéraux AntioXydants' randomised trial (SU.VI.MAX, 1994-2002) and the SU.VI.MAX 2 observational follow-up study (2007-9). 25(OH)D concentrations were measured in plasma samples drawn in 1994-5, using an electrochemoluminescent immunoassay. Cognitive performance was evaluated in 2007-9 with a neuropsychological battery including phonemic and semantic fluency tasks, the RI-48 (rappel indicé-48 items) cued recall test, the Trail Making Test and the forward and backward digit span. Cognitive factors were extracted via principal component analysis (PCA). Data from 1009 individuals, aged 45-60 years at baseline, with available 25(OH)D and cognitive measurements were analysed by multivariable linear regression models and ANCOVA, stratified by educational level. PCA yielded two factors, designated as 'verbal memory' (strongly correlated with the RI-48 and phonemic/semantic fluency tasks) and 'short-term/working memory' (strongly correlated with the digit span tasks). In the fully adjusted regression model, among individuals with low education, there was a positive association between 25(OH)D concentrations and the 'short-term/working memory' factor (P=0.02), mainly driven by the backward digit span (P=0.004). No association with either cognitive factor was found among better educated participants. In conclusion, higher midlife 25(OH)D concentrations were linked to better outcomes concerning short-term and working memory. However, these results were specific to subjects with low education, suggesting a modifying effect of cognitive reserve.


Assuntos
25-Hidroxivitamina D 2/sangue , Envelhecimento , Calcifediol/sangue , Transtornos Cognitivos/etiologia , Deficiência de Vitamina D/fisiopatologia , Adulto , Estudos de Casos e Controles , Transtornos Cognitivos/epidemiologia , Estudos de Coortes , Escolaridade , Feminino , França/epidemiologia , Humanos , Imunoensaio , Estudos Longitudinais , Masculino , Memória de Curto Prazo , Pessoa de Meia-Idade , Análise de Componente Principal , Risco , Aprendizagem Verbal , Deficiência de Vitamina D/sangue
3.
Aging Clin Exp Res ; 26(1): 61-5, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24343852

RESUMO

BACKGROUND AND AIMS: Pictograms, designed to be a universal communication system, are often created from several concrete and easily recognizable drawings. Does understanding depend on a logical approach? Or is it the ability to inhibit the concrete sense of each picture that allows access to a higher level of comprehension? (ability to abstract). These executive functions are sensitive to the effects of aging and educational level. The aim of our study was to evaluate the nature of the cognitive processes underlying the meaning of pictograms and to test the effect of aging and educational level. METHODS: We enrolled 19 older adults (60-69 years old) and 63 young adults (20-29 years old). Of these 63 young adults, 43 had a high educational level (Young-High participants), and 20 had a lower educational level (Young-Low participants). Each participant was asked the meaning of 20 pictograms and underwent an assessment of abstraction and logical abilities with WAIS-III test. RESULTS: Older adults had lower pictogram assessment scores and abstraction and logical abilities when compared with young adults. In both groups, abstraction and logical abilities were correlated with the interpretation of pictograms but only abstraction ability remains strongly correlated with pictogram comprehension in the older group after adjustment of sex, age and educational level. Consequently, the poorer performances of older adults to determine the meaning of pictograms could be explained by the decline of abstraction ability in elderly. CONCLUSIONS: Pictograms are not the universal communication system as we formerly thought. Age and educational level may influence the performance in determining the meaning of pictograms.


Assuntos
Cognição/fisiologia , Escolaridade , Adulto , Fatores Etários , Comunicação , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
4.
Aging Clin Exp Res ; 25(1): 111-3, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23740641

RESUMO

Levetiracetam is frequently used in the elderly considering its favorable pharmacological profile, efficacy, and good tolerance. We reported an encephalopathy with levetiracetam in an elderly subject who had no renal failure, no concomitant valproate medication, and no other additional co-morbidities. Levetiracetam should be discontinued when this condition is suspected.


Assuntos
Anticonvulsivantes/efeitos adversos , Síndromes Neurotóxicas/etiologia , Piracetam/análogos & derivados , Idoso de 80 Anos ou mais , Feminino , Humanos , Levetiracetam , Piracetam/efeitos adversos , Convulsões/induzido quimicamente , Convulsões/tratamento farmacológico
5.
Aging Clin Exp Res ; 24(4): 398-9, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23238315

RESUMO

Myasthenia gravis is not a frequent disease in the elderly. The diagnosis of this neuromuscular junction disease in the elderly is difficult because of comorbidities and the broad differential diagnosis. We report here the case of a 86-year-old woman referred to hospital for loss of weight and difficulties in feeding. She was cachectic and had been suffering from dysphagia for several weeks. One week later, her clinical state worsened with the appearance of ptosis and oropharyngeal dysfunction, disturbing eating and talking. Myasthenia gravis was suspected and confirmed by a positive acetylcholine receptor antibody titer. The clinical state of the patient unfortunately worsened, with acute respiratory insufficiency, causing death. Myasthenia gravis must be suspected in a context of dysphagia, swallowing difficulties and loss of weight. This diagnosis leads to specific and symptomatic treatment and allows neuromuscular blockade-inducing drugs to be avoided.


Assuntos
Desnutrição/diagnóstico , Desnutrição/etiologia , Miastenia Gravis/complicações , Miastenia Gravis/diagnóstico , Idoso , Feminino , Humanos
6.
Soins Gerontol ; (96): 16-20, 2012.
Artigo em Francês | MEDLINE | ID: mdl-22852496

RESUMO

Language disorders in elderly people are not exclusively linked to the vascular pathology. There are many degenerative causes and the different clinical presentations and progression profiles must be known to clinicians. The detection of a language disorder during a "memory consultation" warrants an assessment by a speech therapist, in order to adapt the neuropsychological assessment and to decide on any complementary investigations.


Assuntos
Doença de Alzheimer/complicações , Afasia/etiologia , Humanos , Testes Neuropsicológicos
7.
Psychol Neuropsychiatr Vieil ; 8(4): 255-62, 2010 Dec.
Artigo em Francês | MEDLINE | ID: mdl-21147664

RESUMO

The understanding of the role of vitamin D in maintaining good health has considerably increased in the recent years. There is a growing evidence that vitamin D has not only a beneficial effect to prevent osteoporosis and the risk of falls in the elderly, but also may reduce incidence of cancers, infections, autoimmune, cardiovascular and neurologic diseases, and psychiatric disorders. Laboratory studies yield a biological plausibility for a positive contribution of vitamin D to brain functions: vitamin D receptor and 1,α-hydroxylase, the terminal calcitriol-activating enzyme, are widely distributed in both the fetal and adult brain. Vitamin D may be involved in neuroprotection, control of proinflammatory cytokine induced cognitive dysfunction and synthesis of calcium-binding proteins and neurotransmitter acetylcholine. However, the observational studies conducted in humans are still inconclusive, given the various tests of the cognitive functions that have been used, the performance of the studies either in patients or in healthy subjects, and different designs and/or confounding factors. The role of the vitamin D receptor in the pathophysiology of cognitive decline, incidence of Alzheimer's disease or vascular dementia and/or cognitive decline with respect to previous plasma 25OHD concentration, and the effect on cognition of vitamin D supplementation should be explored in further studies.


Assuntos
Cognição/fisiologia , Deficiência de Vitamina D/psicologia , Vitamina D/farmacologia , Vitamina D/fisiologia , Vitaminas/farmacologia , Adulto , Idoso , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/psicologia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/psicologia , Suplementos Nutricionais , Humanos , Deficiência de Vitamina D/epidemiologia
8.
Psychol Neuropsychiatr Vieil ; 8(3): 201-7, 2010 Sep.
Artigo em Francês | MEDLINE | ID: mdl-20739258

RESUMO

Numerous decision-making situations occur in the activities of daily living. The consequences of the decision-making capacity disturbances may have a great impact on the patient's autonomy, financial management, and his or her reaction to a diagnosis as well as the ability to accept a therapeutic option or give informed consent. Decision-making is a complex and multi-dimensional process and brings into play attention, memory and executive functions, which are processed in the prefrontal cortex, particularly vulnerable in aging. A better comprehension of the mechanisms of decision-making, and of the resulting social consequences of their dysfunction may improve autonomy of the elderly. Unfortunately, we still lack appropriate tools to explore decision-making in routine practice.


Assuntos
Doença de Alzheimer/diagnóstico , Tomada de Decisões , Função Executiva , Atividades Cotidianas/classificação , Atividades Cotidianas/psicologia , Idoso , Doença de Alzheimer/fisiopatologia , Doença de Alzheimer/psicologia , Atenção/fisiologia , Tomada de Decisões/fisiologia , Função Executiva/fisiologia , Humanos , Competência Mental , Rememoração Mental/fisiologia , Testes Neuropsicológicos , Autonomia Pessoal , Córtex Pré-Frontal/fisiopatologia
9.
Psychol Neuropsychiatr Vieil ; 7(1): 65-72, 2009 Mar.
Artigo em Francês | MEDLINE | ID: mdl-19251573

RESUMO

Dichotic listening is the most frequent behavioral test used to assess hemispheric lateralization. The subjects simultaneously receive competing information signals in each ear and the attention resources are mobilized. Dichotic listening may be viewed as a dual-task procedure. In fact, executive functions and attention, which are involved, may be modified in elderly. The aim of this paper is to define the role of dichotic listening for the study of hemispheric interactions in the elderly, according to compensation/reorganization processes in normal and pathological aging.


Assuntos
Idoso/psicologia , Encéfalo/fisiologia , Testes com Listas de Dissílabos , Lateralidade Funcional/fisiologia , Estimulação Acústica , Humanos , Idioma
10.
Psychol Neuropsychiatr Vieil ; 6(1): 49-56, 2008 Mar.
Artigo em Francês | MEDLINE | ID: mdl-18364296

RESUMO

Cerebral hemispheric lateralization is an old concept, particularly concerning language. In children, numerous arguments favour a left hemispheric predisposition for language, but do not exclude its strengthening during childhood. In the elderly, changes in the lateralization have been described. Two models were proposed to explain these changes. The right hemi-aging model is supported by behavioral studies and the age-related asymmetry reduction model is documented by brain imaging studies. We review the data supporting the two models. The significance of this age-related asymmetry reduction is questionable. The dedifferentiation view suggests that bilateral activation in older adults reflects difficulty in recruiting specialized neural mechanisms. Age-related asymmetry reduction may also be evidence of compensatory mechanisms and plasticity of the aging brain. It is useful for understanding physiopathology of cognitive decline and rehabilitation potential of the aging brain.


Assuntos
Envelhecimento/fisiologia , Envelhecimento/psicologia , Lateralidade Funcional/fisiologia , Idoso , Humanos , Fala/fisiologia
11.
JPEN J Parenter Enteral Nutr ; 42(2): 296-307, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29443395

RESUMO

Subcutaneous infusion, or hypodermoclysis, is a technique whereby fluids are infused into the subcutaneous space via small-gauge needles that are typically inserted into the thighs, abdomen, back, or arms. In this review, we provide an overview of the technique, summarize findings from studies that have examined the use of subcutaneous infusion of fluids for hydration or nutrition, and describe the indications, advantages, and disadvantages of subcutaneous infusion. Taken together, the available evidence suggests that, when indicated, subcutaneous infusion can be effective for administering fluids for hydration or nutrition, with minimal complications, and has similar effectiveness and safety to the intravenous route. Of note, subcutaneous infusion offers several advantages over intravenous infusion, including ease of application, low cost, and the lack of potential serious complications, particularly infections. Subcutaneous infusion may be particularly suited for patients with mild to moderate dehydration or malnutrition when oral/enteral intake is insufficient; when placement of an intravenous catheter is not possible, tolerated, or desirable; at risk of dehydration when oral intake is not tolerated; as a bridging technique in case of difficult intravenous access or catheter-related bloodstream infection while infection control treatment is being attempted; and in multiple settings (eg, emergency department, hospital, outpatient clinic, nursing home, long-term care, hospice, and home).


Assuntos
Desidratação/terapia , Hidratação/métodos , Infusões Subcutâneas/métodos , Desnutrição/terapia , Humanos , Hipodermóclise
12.
JPEN J Parenter Enteral Nutr ; 41(7): 1222-1227, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-26888874

RESUMO

BACKGROUND: Many patients who cannot tolerate adequate enteral nutrition could benefit from parenteral nutrition support but fail to receive it due to difficult intravenous (IV) access. The objective of this study was to compare the safety and efficacy of subcutaneous (SC) administration of parenteral nutrition with the peripheral IV route. MATERIALS AND METHODS: This was a prospective randomized multicenter study of 121 older hospitalized patients. The primary outcome was the composite end point of major local side effects, defined as local edema, blistering, erythema, phlebitis, cellulitis, unbearable pain, or route failure requiring a switch in route. Secondary outcomes were nutrition parameters, biochemical parameters, clinical outcomes, and safety. RESULTS: The SC route (n = 59) was noninferior to the IV route (n = 61) for major local side effects. Major local side effects trended higher in the IV group ( P = .059). Local edema was more common in the SC group ( P < .05), while route failure was more common in the IV group ( P < .001). Nutrition and biochemical parameters, safety, and clinical outcomes were similar between groups. CONCLUSIONS: The SC route of nutrient administration was better tolerated than the peripheral IV route. SC administration of parenteral nutrition represents a safe alternative to IV nutrition.


Assuntos
Infusões Subcutâneas , Soluções de Nutrição Parenteral/administração & dosagem , Nutrição Parenteral/métodos , Idoso , Idoso de 80 Anos ou mais , Edema/etiologia , Feminino , Humanos , Infusões Subcutâneas/efeitos adversos , Masculino , Resultado do Tratamento
13.
Int J Infect Dis ; 37: 36-41, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26092300

RESUMO

BACKGROUND: Clostridium difficile infection (CDI) is a common cause of nosocomial diarrhoea. People in the general community are not usually considered to be at risk of CDI. CDI is associated with a high risk of morbidity and mortality. The risk of severity is defined by the Clostridium Severity Index (CSI). METHODS: The cases of 136 adult patients with CDI treated at the University Hospital of Tours, France between 2008 and 2012 are described. This was a retrospective study. RESULTS: Among the 136 patients included, 62 were men and 74 were women. Their median age was 64.4 years (range 18-97 years). Twenty-six of the 136 (19%) cases were community-acquired (CA) and 110 (81%) were healthcare-acquired (HCA). The major risk factors for both groups were long-term treatment with proton pump inhibitors (54% of CA, 53% of HCA patients) and antibiotic treatment within the 2.5 months preceding the CDI (50% of CA, 91% of HCA). The CSI was higher in the CA-CDI group (1.56) than in the HCA-CDI group (1.39). Intensive care was required for 8% of CA-CDI and 16.5% of HCA-CDI patients. CONCLUSIONS: CDI can cause community-acquired diarrhoea, and CA-CDI may be more severe than HCA-CDI. Prospective studies of CDI involving people from the general community without risk factors are required to confirm this observation.


Assuntos
Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/embriologia , Infecções Comunitárias Adquiridas/epidemiologia , Infecção Hospitalar/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Clostridioides difficile/imunologia , Infecções por Clostridium/mortalidade , Infecções Comunitárias Adquiridas/mortalidade , Infecção Hospitalar/mortalidade , Diarreia/epidemiologia , Diarreia/virologia , Feminino , França/epidemiologia , Hospitais Universitários , Humanos , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
14.
Rev Prat ; 53(3): 275-9, 2003 Feb 01.
Artigo em Francês | MEDLINE | ID: mdl-12688058

RESUMO

Malnutrition is highly prevalent in the elderly populations: 4% in the community and near by 50% in the hospital or the long-term care facilities. Insufficient dietary intake results from loneliness, ignorance, impaired functional capacities and iatrogenic conditions. In case of acute injury or infection, stress reaction activates cytokine-induced metabolic events that impair nutritional status. There is a physiological anorexia with aging, but aging alone is not responsible for malnutrition. Diseases, psychological conditions and environmental factors are taken in account to treat malnutrition. Ethical considerations are necessary before tube-feeding decisions in a malnourished aged patient.


Assuntos
Envelhecimento , Distúrbios Nutricionais/epidemiologia , Idoso , Envelhecimento/fisiologia , Envelhecimento/psicologia , Doença Crônica , Ingestão de Energia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Feminino , Humanos , Masculino , Distúrbios Nutricionais/etiologia , Distúrbios Nutricionais/prevenção & controle , Distúrbios Nutricionais/terapia , Prevalência
15.
Front Aging Neurosci ; 6: 22, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24611048

RESUMO

Falls are common in the elderly, and potentially result in injury and disability. Thus, preventing falls as soon as possible in older adults is a public health priority, yet there is no specific marker that is predictive of the first fall onset. We hypothesized that gait features should be the most relevant variables for predicting the first fall. Clinical baseline characteristics (e.g., gender, cognitive function) were assessed in 259 home-dwelling people aged 66 to 75 that had never fallen. Likewise, global kinetic behavior of gait was recorded from 22 variables in 1036 walking tests with an accelerometric gait analysis system. Afterward, monthly telephone monitoring reported the date of the first fall over 24 months. A principal components analysis was used to assess the relationship between gait variables and fall status in four groups: non-fallers, fallers from 0 to 6 months, fallers from 6 to 12 months and fallers from 12 to 24 months. The association of significant principal components (PC) with an increased risk of first fall was then evaluated using the area under the Receiver Operator Characteristic Curve (ROC). No effect of clinical confounding variables was shown as a function of groups. An eigenvalue decomposition of the correlation matrix identified a large statistical PC1 (termed "Global kinetics of gait pattern"), which accounted for 36.7% of total variance. Principal component loadings also revealed a PC2 (12.6% of total variance), related to the "Global gait regularity." Subsequent ANOVAs showed that only PC1 discriminated the fall status during the first 6 months, while PC2 discriminated the first fall onset between 6 and 12 months. After one year, any PC was associated with falls. These results were bolstered by the ROC analyses, showing good predictive models of the first fall during the first six months or from 6 to 12 months. Overall, these findings suggest that the performance of a standardized walking test at least once a year is essential for fall prevention.

18.
Geriatr Psychol Neuropsychiatr Vieil ; 9(4): 477-89, 2011 Dec.
Artigo em Francês | MEDLINE | ID: mdl-22182825

RESUMO

The consequences of hypothyroidism on cognition are long known since the description of dementia associated with hypothyroidism. Additional data from experimental studies support the impact of thyroid hormones on the central nervous system and cognition. Cognitive impairment in relation with hypothyroidism (even sub clinical hypothyroidism) in elderly subjects involves memory, attention, and executive functions. Hypothyroidism may be associated with somatic, neurologic, psychiatric, social and environmental data. Cross-sectional and longitudinal studies are frequently heterogeneous but suggest a complex relationship between hypothyroidism and cognition.


Assuntos
Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Hipotireoidismo/complicações , Hipotireoidismo/diagnóstico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Animais , Encéfalo/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Estudos Transversais , Demência/fisiopatologia , Feminino , Humanos , Hipotireoidismo/fisiopatologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Hormônios Tireóideos/sangue , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-21916665

RESUMO

INTRODUCTION: The aim of this study was to evaluate whether the classic asymmetry seen in hemispheric functioning is modified in older adults by using a verbal-manual concurrency task. METHOD: Thirty-five right-handed participants divided into two groups according to age (15 older participants, mean age: 68 ? 8 years, without cognitive decline and 20 younger participants, mean age: 23 ? 2 years) had to perform a 30-second uni-manual tapping task, in both a single task (tapping alone) and dual task (tapping and performing a letter fluency task together) condition. RESULTS: In younger participants, the letter fluency task disrupted the right hand more than the left hand whereas, in older participants, the letter fluency task disrupted both hands equally. CONCLUSION: These results should be considered preliminary data using a behavioral dual task condition, which might be useful for studying lateralized hemispheric functioning and the processes of divided attention during aging.


Assuntos
Envelhecimento/fisiologia , Atenção/fisiologia , Lateralidade Funcional/fisiologia , Adulto , Idoso , Humanos , Modelos Psicológicos , Tempo de Reação , Comportamento Verbal
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