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1.
Alzheimers Dement ; 17(9): 1415-1421, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33656287

RESUMO

INTRODUCTION: Studies on the association of cancer and risk of dementia are inconclusive due to result heterogeneity and concerns of survivor bias and unmeasured confounding. METHODS: This study uses data from the Memento cohort, a French multicenter cohort following persons with either mild or isolated cognitive complaints for a median of 5 years. Illness-death models (IDMs) were used to estimate transition-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for incident cancer in relation to dementia from time since study entry. RESULTS: The analytical sample (N = 2258) excluded 65 individuals without follow-up information. At the end of follow-up, 286 individuals were diagnosed with dementia, 166 with incident cancer, and 95 died. Incident cancer was associated with a reduced risk of dementia (HR = 0.58, 95% CI = 0.35-0.97), with a corresponding E-value of 2.84 (lower CI = 1.21). DISCUSSION: This study supports a protective relationship between incident cancer and dementia, encouraging further investigations to understand potential underlying mechanisms.


Assuntos
Disfunção Cognitiva , Demência/epidemiologia , Neoplasias/epidemiologia , Idoso , Estudos de Coortes , Feminino , França/epidemiologia , Humanos , Masculino , Mortalidade/tendências , Testes Neuropsicológicos
2.
BMC Geriatr ; 15: 63, 2015 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-26062790

RESUMO

BACKGROUND: In the 1990s, epidemiological studies estimated the prevalence of stroke caused by atrial fibrillation (AF) at about 15 %. Given the aging population, there is a rise in the number of AF patients. AF prevention guidelines based on clinical practice and the literature have been published and updated since 2001. Implementation seems to have an impact on the prescription of vitamin K antagonist (VKA). During the last 20 years, few population-based studies have focused on the prevalence of atrial arrhythmia (AA) in patients with stroke. The objective of the present prospective study, using data from 2008, was to evaluate the prevalence of AA (atrial fibrillation/flutter) in patients with stroke and the impact of implementing AF guidelines. METHODS: The prevalence of AA was studied in patients diagnosed with stroke from January 1 to December 31, 2008 in the population-based Stroke Registry of Brest, France (total population, 363,760 according to the 2008 census, with 295,553 aged 15 years or older). Guidelines implementation was assessed in terms of antithrombotic therapy (VKA, antiplatelet agent, none), and the CHADS2 (Congestive heart failure, Hypertension, Age > 75 years, Diabetes mellitus, and prior Stroke or transient ischemic attack). RESULTS: 851 cases of stroke were identified. The prevalence of AA was 31.7 % (n = 264), and increased with age from < 20 % in patients aged 45 to 54 years to nearly 50 % in patients ≥ 85 years. In patients with AA, 231 strokes were ischemic, 28 hemorrhagic and 5 undetermined. At time of stroke, AA was known in 207 patients (78.4 %). 54 of the 152 patients with CHADS2 score ≥ 2 (35.5 %) were treated with VKA; this proportion decreased with age: 50 % between 50 and 74 years, 43.8 % between 75 and 84 years, and 25 % at 85 years and older. CONCLUSION: The prevalence of AA in the population-based Brest Stroke Registry in 2008 was higher than that reported by studies conducted 20 years ago. Despite publication of AF prevention guidelines, VKA prescription and use in elderly patients were significantly low.


Assuntos
Fibrilação Atrial/epidemiologia , Flutter Atrial/epidemiologia , Sistema de Registros , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Flutter Atrial/complicações , Flutter Atrial/tratamento farmacológico , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Prevalência , Estudos Prospectivos , Acidente Vascular Cerebral/prevenção & controle , Adulto Jovem
3.
Maturitas ; 143: 115-117, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33308616

RESUMO

Peripheral neuropathies (PN) in older adults often involve altered vibrational perception, i.e. hypopallesthesia. The main objective of this cross-sectional study was to determine whether age-related lower-limb hypopallesthesia is associated with a history of falls in cognitively intact non-diabetic older adults. The study population comprised 157 people (mean, 71.5 ± 3.8years, 45.3 % female, 19.7 % with a history of falls). Fallers more often exhibited hypopallesthesia than non-fallers (13.3 % versus 1.6 %, P = 0.04). Multiple logistic regression showed that hypopallesthesia (odds ratio (OR) = 19.5 [95 % confidence interval (CI): 2.7-143.7], P = 0.004) was associated with the history of falls in this sample of cognitively intact non-diabetic older adults.


Assuntos
Acidentes por Quedas , Extremidade Inferior , Doenças do Sistema Nervoso Periférico/epidemiologia , Idoso , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Fatores de Risco
4.
Alzheimers Res Ther ; 9(1): 67, 2017 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-28851447

RESUMO

BACKGROUND: The natural history and disease mechanisms of Alzheimer's disease and related disorders (ADRD) are still poorly understood. Very few resources are available to scrutinise patients as early as needed and to use integrative approaches combining standardised, repeated clinical investigations and cutting-edge biomarker measurements. METHODS: In the nationwide French MEMENTO cohort study, participants were recruited in memory clinics and screened for either isolated subjective cognitive complaints (SCCs) or mild cognitive impairment (MCI; defined as test performance 1.5 SD below age, sex and education-level norms) while not demented (Clinical Dementia Rating [CDR] <1). Baseline data collection included neurological and physical examinations as well as extensive neuropsychological testing. To be included in the MEMENTO cohort, participants had to agree to undergo both brain magnetic resonance imaging (MRI) and blood sampling. Cerebral 18F-fluorodeoxyglucose positon emission tomography and lumbar puncture were optional. Automated analyses of cerebral MRI included assessments of volumes of whole-brain, hippocampal and white matter lesions. RESULTS: The 2323 participants, recruited from April 2011 to June 2014, were aged 71 years, on average (SD 8.7), and 62% were women. CDR was 0 in 40% of participants, and 30% carried at least one apolipoprotein E ε4 allele. We observed that more than half (52%) of participants had amnestic mild cognitive impairment (17% single-domain aMCI), 32% had non-amnestic mild cognitive impairment (16.9% single-domain naMCI) and 16% had isolated SCCs. Multivariable analyses of neuroimaging markers associations with cognitive categories showed that participants with aMCI had worse levels of imaging biomarkers than the others, whereas participants with naMCI had markers at intermediate levels between SCC and aMCI. The burden of white matter lesions tended to be larger in participants with aMCI. Independently of CDR, all neuroimaging and neuropsychological markers worsened with age, whereas differences were not consistent according to sex. CONCLUSIONS: MEMENTO is a large cohort with extensive clinical, neuropsychological and neuroimaging data and represents a platform for studying the natural history of ADRD in a large group of participants with different subtypes of MCI (amnestic or not amnestic) or isolated SCCs. TRIAL REGISTRATION: Clinicaltrials.gov, NCT01926249 . Registered on 16 August 2013.


Assuntos
Encéfalo/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/psicologia , Idoso , Encéfalo/metabolismo , Disfunção Cognitiva/sangue , Disfunção Cognitiva/líquido cefalorraquidiano , Autoavaliação Diagnóstica , Feminino , Fluordesoxiglucose F18 , Seguimentos , França , Humanos , Processamento de Imagem Assistida por Computador , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Neuroimagem , Testes Neuropsicológicos , Tamanho do Órgão , Reconhecimento Automatizado de Padrão , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Projetos de Pesquisa , Punção Espinal
5.
Thromb Haemost ; 115(1): 169-75, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26538494

RESUMO

The prevalence of both vitamin D deficiency and venous thromboembolism (VTE) is important in the elderly. Previous studies have provided evidence for a possible association between vitamin D status and the risk of VTE. Thus, we aimed to investigate the association between vitamin D levels and VTE in the population aged 75 and over included in the EDITH case-control study. The association between vitamin D status and VTE was analysed. We also analysed the monthly and seasonal variations of VTE and vitamin D. Between May 2000 and December 2009, 340 elderly patients (mean age 81.5 years, 32% men) with unprovoked VTE and their controls were included. The univariate and multivariate analysis found no significant association between serum levels of vitamin D and the risk of unprovoked VTE. In the unadjusted analysis, a higher BMI was statistically associated with an increased risk of VTE (OR 1.09; 95% CI 1.05-1.13) whereas a better walking capacity and living at home were associated with a decreased rate of VTE: OR 0.57; 95% CI 0.36-0.90 and 0.40; 95% CI 0.25-0.66, respectively. Although not significant, more VTE events occurred during winter (p=0.09). No seasonal variations of vitamin D levels were found (p=0.11). In conclusion, in contrast with previous reports our findings suggest that vitamin D is not associated with VTE in the elderly population.


Assuntos
Tromboembolia Venosa/epidemiologia , Deficiência de Vitamina D/epidemiologia , Vitamina D/análogos & derivados , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Índice de Massa Corporal , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Feminino , França/epidemiologia , Avaliação Geriátrica , Humanos , Incidência , Vida Independente , Modelos Logísticos , Masculino , Análise Multivariada , Obesidade/epidemiologia , Razão de Chances , Prevalência , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Estações do Ano , Fatores de Tempo , Tromboembolia Venosa/sangue , Tromboembolia Venosa/diagnóstico , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Caminhada
6.
Arch Cardiovasc Dis ; 106(5): 303-23, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23769405

RESUMO

Atrial fibrillation (AF) is a common and serious condition in the elderly. AF affects between 600,000 and one million patients in France, two-thirds of whom are aged above 75 years. AF is a predictive factor for mortality in the elderly and a major risk factor for stroke. Co-morbidities are frequent and worsen the prognosis. The management of AF in the elderly should involve a comprehensive geriatric assessment (CGA), which analyses both medical and psychosocial elements, enabling evaluation of the patient's functional status and social situation and the identification of co-morbidities. The CGA enables the detection of "frailty" using screening tools assessing cognitive function, risk of falls, nutritional status, mood disorders, autonomy and social environment. The objectives of AF treatment in the elderly are to prevent AF complications, particularly stroke, and improve quality of life. Specific precautions for treatment must be taken because of the co-morbidities and age-related changes in pharmacokinetics or pharmacodynamics. Preventing AF complications relies mainly on anticoagulant therapy. Anticoagulants are recommended in patients with AF aged 75 years or above after assessing the bleeding risk using the HEMORR2HAGES or HAS-BLED scores. Novel oral anticoagulants (NOACs) are promising treatments, especially due to a lower risk of intracerebral haemorrhage. However, their prescriptions should take into account renal function (creatinine clearance assessed with Cockcroft formula) and cognitive function (for adherence to treatment). Studies including frail patients in "real life" are necessary to evaluate tolerance of NOACs. Management of AF also involves the treatment of underlying cardiomyopathy and heart rate control rather than a rhythm-control strategy as first-line therapy for elderly patients, especially if they are paucisymptomatic. Antiarrhythmic drugs should be used carefully in elderly patients because of the frequency of metabolic abnormalities and higher risk of drug interactions and bradycardia.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/terapia , Cardiologia/normas , Geriatria/normas , Sociedades Médicas/normas , Acidente Vascular Cerebral/prevenção & controle , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antiarrítmicos/efeitos adversos , Anticoagulantes/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Comorbidade , Consenso , Interações Medicamentosas , França , Avaliação Geriátrica , Hemorragia/induzido quimicamente , Humanos , Pessoa de Meia-Idade , Polimedicação , Valor Preditivo dos Testes , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
7.
Geriatr Psychol Neuropsychiatr Vieil ; 11(2): 117-43, 2013 Jun.
Artigo em Francês | MEDLINE | ID: mdl-23803629

RESUMO

The prevalence of atrial fibrillation (AF) increase with ageing. In France AF affects between 400,000 to 660,000 people aged 75 years or more. In the elderly, AF is a major risk factor of stroke and a predictive factor for mortality. Comorbidities are frequent and worsen the prognosis of AF. They can be the cause or the consequence of AF and their management is a major therapeutic objective. Comprehensive geriatric assessment (CGA), is required to analyse both medical and psychosocial elements, and to identify co-morbidities and geriatrics syndrome as cognitive disorders, risk of falls, malnutrition, mood disorders, and lack of dependency and social isolation. The objectives of AF treatment in the elderly are to prevent AF complications, particularly stroke, and to improve quality of life. Specific precautions for treatment must be taken because of the co-morbidities and age-related changes in pharmacokinetics or pharmacodynamics. Preventing AF complications relies mainly on anticoagulant therapy. Anticoagulants are recommended in patients with AF aged ≥ 75 years after assessing the bleeding risk using Hemorr2hages or HAS-BLED scores. Novel oral anticoagulants (NOACs) are promising treatments especially due to a lower risk of intracerebral haemorrhage. However, their prescriptions should take into account renal function (creatinine clearance assessed with Cockcroft formula) and cognitive function (for adherence to treatment). Studies including very old patients with several comorbidities in 'real life' are necessary to evaluate tolerance of NOACs in this population. The management of AF also involves the treatment of underlying cardiomyopathy and heart rate control rather than rhythm control strategy as first-line therapy in the elderly.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Cardiologia , Geriatria , Sociedades Médicas , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/mortalidade , Causas de Morte , Comorbidade , França , Avaliação Geriátrica , Humanos , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/prevenção & controle , Qualidade de Vida , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/prevenção & controle
8.
Artigo em Francês | MEDLINE | ID: mdl-21586371

RESUMO

Frailty as a geriatric concept has been considered as the beginning of a rapid downward spiral towards death. Nevertheless, the French word "fragilité" is different from frailty - and probably an erroneous translation. Furthermore, frailty can be considered as belonging to the human condition as such.


Assuntos
Idoso Fragilizado , Filosofia , Relações Médico-Paciente , Populações Vulneráveis , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/psicologia , Doença Crônica/terapia , Comparação Transcultural , França , Humanismo , Humanos , Preconceito
10.
Geriatr Psychol Neuropsychiatr Vieil ; 9(4): 387-90, 2011 Dec.
Artigo em Francês | MEDLINE | ID: mdl-22182814

RESUMO

Frailty in the older population is a clinical syndrome which evaluate a risk level. The Frailty syndrome defines a reduction of the adaptation capacity to a stress. It can be modulated by physical, psychological and social factors. The screening of the frailty syndrome is relevant for older people without disability for basic activities of daily living. The clinical criteria of frailty must be predictive of the risk of functional decline and adverse outcomes, consensual at the international level, and easy to perform in primary care as well as in the clinical researches.


Assuntos
Idoso Fragilizado , Geriatria , Sociedades Médicas , Atividades Cotidianas/classificação , Idoso , Idoso de 80 Anos ou mais , Humanos , Programas de Rastreamento , Atenção Primária à Saúde , Medição de Risco , Síndrome
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