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OBJECTIVE: In Alzheimer's disease (AD), the burden on caregivers is influenced by various factors, including the stage of disease progression and neuropsychiatric symptoms (NPS). To date, there has been limited research examining how patient's premorbid personality could affect this burden. The objective of this study was to investigate the impact of both premorbid personality and NPS in individuals with prodromal to mild AD on their caregivers' burden. METHOD: One hundred eighty participants with prodromal or mild AD drown from the PACO (in French: Personnalité Alzheimer COmportement) cohort were included. Personality was assessed by the Revised NEO Personality Inventory (NEO-PI-R). Neuropsychiatric symptoms were measured with the short version of the Neuropsychiatric Inventory (NPI-Q), and caregiver burden was evaluated with the Zarit burden scale. Relationships between personality, Neuro-Psychiatric Inventory (NPI) scores, and caregiver burden were determined using multivariate linear regressions controlled for age, sex, educational level, and Mini Mental State Examination. RESULTS: The total NPI score was related to increased burden (beta = 0.45; p < 0.001). High level of neuroticism (beta = 0.254; p = 0.003) et low level of conscientiousness (beta = - 0.233; p = 0.005) were associated higher burden. Extraversion (beta = -0.185; p = 0.027) and conscientiousness (beta = -0.35; p = 0.006) were negatively associated with burden. In contrast, neuroticism, openness and agreeableness were not correlated with burden. When adjusted on total NPI score, the relationship between extraversion and conscientiousness didn't persist. CONCLUSION: Our results suggest that premorbid personality of patients with prodromal to mild Alzheimer influence caregivers's burden, with a protective effect of a high level of extraversion and conscientiousness.
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Doença de Alzheimer , Personalidade , Sintomas Prodrômicos , Humanos , Doença de Alzheimer/psicologia , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Sobrecarga do Cuidador/psicologia , Pessoa de Meia-Idade , Inventário de Personalidade , Cuidadores/psicologia , Efeitos Psicossociais da Doença , Modelos Lineares , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , FrançaRESUMO
BACKGROUND: The association between the pattern of cortical thickness (CT) and executive dysfunction (ED) in mild cognitive impairment (MCI) and subjective cognitive complaints (SCC) is still poorly understood. We aimed to investigate the association between CT and ED in a large French cohort (MEMENTO) of 2323 participants with MCI or SCC. METHODS: All participants with available CT and executive function data (verbal fluency and Trail Making Test [TMT]) were selected (n=1924). Linear regressions were performed to determine relationships between executive performance and the brain parenchymal fraction (BPF) and CT using FreeSurfer. RESULTS: The global executive function score was related to the BPF (sß: 0.091, P<0.001) and CT in the right supramarginal (sß: 0.060, P=0.041) and right isthmus cingulate (sß: 0.062, P=0.011) regions. Literal verbal fluency was related to the BPF (sß: 0.125, P<0.001) and CT in the left parsorbitalis region (sß: 0.045, P=0.045). Semantic verbal fluency was related to the BPF (sß: 0.101, P<0.001) and CT in the right supramarginal region (sß: 0.061, P=0.042). The time difference between the TMT parts B and A was related to the BPF (sß: 0.048, P=0.045) and CT in the right precuneus (sß: 0.073, P=0.019) and right isthmus cingulate region (sß: 0.054, P=0.032). CONCLUSIONS: In a large clinically based cohort of participants presenting with either MCI or SCC (a potential early stage of Alzheimer's disease [AD]), ED was related to the BPF and CT in the left pars orbitalis, right precuneus, right supramarginal, and right isthmus cingulate regions. This pattern of lesions adds knowledge to the conventional anatomy of ED and could contribute to the early diagnosis of AD.
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Health professionals are currently facing the challenge of managing an increasing number of old patients presenting with acute stroke, due to rapid aging of the population. Compared to their younger counterparts, elderly patients differ in many ways in the setting of acute stroke. Apart from a striking high stroke incidence, which increases exponentially as age increases, cardioembolism also becomes, as patients age, the main cause of ischemic stroke. Delirium, which can challenge the diagnosis, is frequent at the acute phase of stroke, and may be related to an underlying dementia, which is almost exclusively observed in the elderly during stroke. At all levels, management of elderly stroke patients is suboptimal, especially when they are cognitively impaired, with insufficiencies including admission to stroke units, applying standards of care and investigation, reperfusion therapy for ischemic stroke, and finally transfer to rehabilitation centers. A paradigm shift must take place to limit age-related discrimination for acute-phase management of stroke.
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Acidente Vascular Cerebral , Idoso , Humanos , Incidência , Centros de ReabilitaçãoRESUMO
BACKGROUND AND PURPOSE: Elderly patients exposed to drugs with anticholinergic or sedative properties may have an increased risk of adverse events. This study aimed to assess the relationship between patient characteristics and changes of exposure to anticholinergic and sedative medications during their hospital stay. METHODS: A multicentre longitudinal study was set up on hospitalized patients (aged ≥65 years) using at least one drug at admission. The primary outcome was change of exposure to anticholinergic and sedative drugs between admission and discharge. Sociodemographic characteristics of the patients, comorbidities, life habits and information about the hospital stay (origin of admission, reasons for hospitalization) were collected. RESULTS: The study included 337 patients (mean age, 85.4 years) with an average hospital stay of 30.1 ± 37.5 days. The drug burden index increased during the hospital stay among males (P = 0.03), patients for whom the reason for hospitalization was either a stroke (P = 0.001) or inability to stay in their own home (P = 0.001), and patients with diabetes mellitus (P = 0.009). In the adjusted model, drug burden index increased among patients hospitalized for stroke, inability to stay in their own home or post-surgery, and for patients with diabetes mellitus or hypertension. CONCLUSIONS: The drug management of elderly patients during hospital stays may increase exposure to anticholinergic and sedative drugs. Although the anticholinergic and sedative properties may be in relation to the therapeutic purpose, they also represent an unexpected risk. Physicians and clinical pharmacists should consider performing optimization of the drug prescriptions for patients at risk.
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Antagonistas Colinérgicos/efeitos adversos , Hipnóticos e Sedativos/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Antagonistas Colinérgicos/uso terapêutico , Complicações do Diabetes/psicologia , Feminino , Hospitalização , Humanos , Hipnóticos e Sedativos/uso terapêutico , Tempo de Internação , Estilo de Vida , Estudos Longitudinais , Masculino , Medição de Risco , Fatores Socioeconômicos , Resultado do TratamentoRESUMO
BACKGROUND: This study aims to review the methodologies used to identify the needs, the existing needs assessment instruments and the main topics of needs explored among caregivers of patients with mild cognitive impairment to dementia. METHODS: MEDLINE, PsycINFO, The Cochrane Library and Web of science were searched from January 1980 to January 2017. Research studies in English or French were eligible for inclusion if they fulfilled the following criteria: quantitative, qualitative and mixed method studies that used instrument, focus group or semi-structured interviews to assess the informal caregiver's needs in terms of information, coping skills, support and service. RESULTS: Seventy studies (n = 39 quantitative studies, n = 25 qualitative studies and n = 6 mixed method studies) met the inclusion criteria and were included. Thirty-six quantitative instruments were identified but only one has been validated for the needs assessment of dementia caregivers: the Carer's Needs Assessment for Dementia (CNA-D). The main areas of needs explored in these instruments were: information, psychosocial, social, psychoeducational and other needs. CONCLUSIONS: No instrument has been developed and validated to assess the needs of informal caregivers of patients with cognitive impairment, whatever the stage and the etiology of the disease. As the perceived needs of caregivers may evolve with the progression of the disease and the dementia transition, their needs should be regularly assessed.
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Doença de Alzheimer/complicações , Cuidadores/psicologia , Disfunção Cognitiva , Fadiga de Compaixão , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Disfunção Cognitiva/terapia , Fadiga de Compaixão/etiologia , Fadiga de Compaixão/prevenção & controle , Fadiga de Compaixão/psicologia , Efeitos Psicossociais da Doença , Progressão da Doença , Humanos , Avaliação das Necessidades , Apoio SocialRESUMO
Assessing morphological, perfusion and metabolic brain changes preceding or associated with neuropsychiatric symptoms (NPSs) will help in the understanding of pathophysiological underlying processes in Alzheimer's disease (AD). This review aimed to highlight the main findings on significant associations between neuroimaging and NPSs, the pathophysiology to elucidate possible underlying mechanisms, and methodological issues to aid future research. Research papers published from January 1990 to October 2015 were identified in the databases PsycInfo, Embase, PubMed and Medline, using key words related to NPSs and imaging techniques. In addition to a semi-systematic search in the databases, we also performed hand searches based on reported citations identified to be of interest. Delusions, apathy and depression symptoms were particularly associated with brain changes in AD. The majority of studies disclosed an association between frontal lobe structural and/or metabolic changes and NPSs, implicating, interestingly, for all 12 NPSs studied, the anterior cingulate cortex although temporal, subcortical and parietal regions, and insula were also involved. Given the high degree of connectivity of these brain areas, frontal change correlates of NPSs may help in the understanding of neural network participation. This review also highlights crucial methodological issues that may reduce the heterogeneity of results to enable progress on the pathophysiological mechanisms and aid research on NPS treatments in AD. Based on a broad review of the current literature, a global brain pattern to support the huge heterogeneity of neuroimaging correlates of NPSs in AD and methodological strategies are suggested to help direct future research.
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Doença de Alzheimer , Apatia/fisiologia , Córtex Cerebral , Delusões , Depressão , Neuroimagem , Doença de Alzheimer/complicações , Doença de Alzheimer/diagnóstico por imagem , Doença de Alzheimer/patologia , Doença de Alzheimer/fisiopatologia , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/patologia , Córtex Cerebral/fisiopatologia , Delusões/diagnóstico por imagem , Delusões/etiologia , Delusões/fisiopatologia , Depressão/diagnóstico por imagem , Depressão/etiologia , Depressão/fisiopatologia , HumanosRESUMO
BACKGROUND AND PURPOSE: Preventing behavioural crises appears to be crucial to promote quality of life of the patient-caregiver dyad, to reduce inappropriate hospitalizations and to delay institutionalization. The Alzheimer Cooperative Valuation in Europe promotes mobile care to prevent patients from severe behavioural and psychological symptoms in dementia. This study assessed the potential efficacy of a mobile team for Alzheimer's disease on hospitalization sparing and behavioural disorder reduction. METHODS: A cohort study was set up from 1 January 2012 to 31 December 2013 by the Clinical and Research Memory Centre of Lyon (France). It included patients with behavioural and psychological symptoms living at home or in a nursing home. An interview explored the alternative patient pathways used by general practitioners (GPs) if the mobile team had not existed (hospitalization sparing). The Neuropsychiatry Inventory score was assessed at inclusion and 30 days later. The sample included 424 consecutive patients with Alzheimer's disease or related disorders and behavioural disorders at any cognitive and functional stage of the disease, taken in charge by the mobile team. RESULTS: Amongst the 424 patients (84.0 ± 7.2 years), 220 (51.9%) hospitalizations were considered by their GPs and 181 (82.3%) were avoided. The Neuropsychiatric Inventory score declined after mobile team intervention (45.8-29.9, P < 0.001). Sleep and appetite disorders, endangered situation and caregiver burnout were associated with higher risk of hospitalization at 30 days. CONCLUSIONS: The mobile team for Alzheimer's disease allows a high proportion of hospitalizations related to behavioural disorders to be avoided and may help to reduce behavioural disorders.
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Doença de Alzheimer/terapia , Cuidadores/psicologia , Demência/terapia , Hospitalização , Equipe de Assistência ao Paciente , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Estudos de Coortes , Demência/diagnóstico , Demência/psicologia , Europa (Continente) , Feminino , França , Humanos , Masculino , Estudos ProspectivosRESUMO
BACKGROUND AND PURPOSE: Almost half of elderly patients being consulted in memory clinics present anxiety disorders, either with or without an associated depressive syndrome. This study investigates the relationship between the level of anxiety and cognitive performance in a population complaining of memory difficulties. METHODS: The study population (n = 149) was selected from the EVATEM cohort, which included subjects aged 65 years or older. All subjects presented memory complaints and patients with depression were excluded. Anxiety level was assessed with the Hamilton Anxiety Rating Scale. A standard neuropsychological battery, including a free and cued episodic memory test, was administered to examine the different processes of verbal episodic memory, visual memory, executive, visuoconstructive and instrumental functions. RESULTS: Subjects with moderate to severe anxiety had worse performance than subjects with no anxiety in retrieval and storage processes of verbal episodic memory (respectively P = 0.004 and P = 0.02) and in visual recognition memory (P = 0.01). No relationship was found between anxiety and executive, visual-constructive or instrumental functions. CONCLUSION: Anxiety impacts several stages of verbal memory, notably the processes of storage and retrieval, and visual recognition memory within a population having cognitive complaints. This study suggests that anxiety should be considered as a factor of memory vulnerability for patients being treated in memory clinics.
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Transtornos de Ansiedade/psicologia , Ansiedade/psicologia , Cognição/fisiologia , Transtornos da Memória/psicologia , Memória/fisiologia , Idoso , Ansiedade/complicações , Transtornos de Ansiedade/complicações , Estudos de Coortes , Estudos Transversais , Função Executiva/fisiologia , Feminino , Humanos , Masculino , Transtornos da Memória/complicações , Testes NeuropsicológicosRESUMO
BACKGROUND AND PURPOSE: Dementia is a leading cause of dependence amongst the aged population. Early identification of cognitive impairment could help to delay advanced stages of dependence. This study aimed at assessing the performance of three neuropsychological tests to detect cognitive disorders in elderly subjects with memory complaints. METHODS: The EVATEM study is a prospective multicentre cohort with a 1-year follow-up. Subjects with memory complaints were selected during preventive health examinations, and three neuropsychological tests (five-word, cognitive disorders examination, verbal fluency) were administered. Two groups were identified in memory clinics: (i) cognitively healthy individuals (CHI) and (ii) mild cognitive impairment or demented individuals (MCI-DI). Cross-sectional analyses were performed on data at inclusion. The relationship between the diagnosis of MCI-DI/CHI and the neuropsychological tests was assessed using logistic regressions. The performance of the neuropsychological tests, individually and combined, to detect cognitive disorders was calculated. RESULTS: Of 585 subjects, 31.11% had cognitive disorders (MCI, 176 subjects; DI, six subjects). Amongst the three tests studied, the odds ratio for MCI-DI was higher for the five-word test <10 [odds ratio 3.2 (1.81; 5.63)]. The best performance was observed when the three tests were combined: specificity 90.5% and sensitivity 42.4% compared to respectively 89.2% and 28.3% for the five-word test. CONCLUSIONS: Despite the poor sensitivity of the five-word test, it seems to be the most adapted for the diagnosis of MCI-DI in older adults with a memory complaint, in prevention centres, taking into account its high specificity and its rapid administration compared to the other tests.
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Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Vida Independente/estatística & dados numéricos , Transtornos da Memória/diagnóstico , Testes Neuropsicológicos , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/epidemiologia , Estudos Transversais , Demência/epidemiologia , Feminino , Seguimentos , França/epidemiologia , Humanos , Masculino , Transtornos da Memória/epidemiologiaRESUMO
A central issue in olfaction concerns the characterization of loss of olfactory function: partial (hyposmia) or total (anosmia). This paper reports the application in a clinical setting of the European Test of Olfactory Capabilities (ETOC), combining odor detection and identification. The study included three phases. In phase 1, anosmics, hyposmics and controls were tested with the 16-items version of the ETOC. In phase 2, a short version of the ETOC was developed: patients with and controls without olfactory impairment were tested on a 6-items ETOC. In phase 3, to predict olfactory impairments in new individuals, the 16-items ETOC was administered on samples of young and older adults, and the 6-items version was applied in samples of young, elderly participants and Alzheimer patients. In phase 1, linear discriminant analysis (LDA) of ETOC scores classified patients and controls with 87.5 % accuracy. In phase 2, LDA provided 84 % correct classification. Results of phase 3 revealed: (1) 16-items ETOC: whereas in young adults, 10 % were classified as hyposmic and 90 % as normosmic, in elderly, 1 % were classified as anosmic, 39 % hyposmic and 60 % normosmic; (2) 6-items ETOC: 15 % of the young adults were classified as having olfactory impairment, compared to 28 % in the older group and 83 % in Alzheimer patients. In conclusion, the ETOC enables characterizing the prevalence of olfactory impairment in young subjects and in normal and pathological aging. Whereas the 16-items ETOC is more discriminant, the short ETOC may provide a fast (5-10 min) tool to assess olfaction in clinical settings.
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Envelhecimento , Odorantes/análise , Transtornos do Olfato/diagnóstico , Olfatometria/métodos , Olfato/fisiologia , Adulto , Idoso , Europa (Continente)/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/epidemiologia , Transtornos do Olfato/fisiopatologia , Reprodutibilidade dos TestesRESUMO
SETTING: Cares in outpatient hospital for elderly patients is a period of interest for multidisciplinary reassessment and pharmaceutical care of the prescription. The objective is to present the implementation of the pharmaceutical care activity at the outpatient hospital. METHODS: Between August and October 2011, elderly patients hospitalized in the outpatient hospital for a brief appraisal had a pharmaceutical care. The clinician introduced pharmaceutical reviews in the synthesis letter for general practitioner. An analysis of the activity was carried out over 3 months. RESULTS: A pharmaceutical care had been realized for 67 patients, mean age of 81.7 years. Among medical related problems identified, 39.6% were for potentially unnecessary medication. A stop was proposed for 44% of pharmaceutical interventions. A total of 91 pharmaceutical interventions and 13 recommendations were made and 34% of patients had potentially inappropriate medication. CONCLUSION: According to the objective to reduce the therapeutics contributing to the iatrogenesis, this approach allowed us to undertake a multidisciplinary collaboration oriented toward the relay between hospital and city cares.
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Geriatria/organização & administração , Ambulatório Hospitalar/organização & administração , Assistência Farmacêutica/organização & administração , Farmacêuticos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Prescrição Inadequada , MasculinoRESUMO
INTRODUCTION: Cognitive-behavioral units (CBUs) have been created in the context of the national Alzheimer plan 2008/2012 for the management of behavioral disorders of patients suffering from Alzheimer's disease or related diseases. The Alzheimer plan promotes the evaluation of these units through the observation of the evolution of behavioral and psychological symptoms of dementia (BPSD). The aim of this study was to assess the effects of the memory center of Lyon (hospices civils de Lyon) CBU on BPSD. PATIENTS: The neuropsychiatric inventory (NPI) was rated by the patients' caregiver (NPI-F) at admission to the CBU and 2 weeks after the discharge. The NPI was also rated by the nursing staff (NPI-NS) 3 days after admission in the CBU and at discharge. RESULTS: All patients admitted in the CBU between July and October 2001 were included in the study for a total of 28 patients. A significant reduction of NPI-F scores between admission (58.93 ± 24.8) and 2 weeks after the discharge (27.07 ± 19.70) (P<0.0001) was observed. Improvement was specifically observed for delusions, agitation, depression, anxiety, disinhibition and aberrant motor activity symptoms. No significant changes were found on NPI-NS scores. CONCLUSION: This study discloses benefits of CBUs in terms of BPSD reduction in patients 2 weeks after CBU discharge. These units have the potential to achieve their principal objective of reducing behavioral problems.
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Sintomas Comportamentais/terapia , Terapia Cognitivo-Comportamental , Demência/terapia , Unidades Hospitalares , Idoso , Idoso de 80 Anos ou mais , Sintomas Comportamentais/etiologia , Cuidadores/psicologia , Demência/complicações , Demência/psicologia , Feminino , Seguimentos , Humanos , Masculino , Testes Neuropsicológicos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Low serum 25-hydroxyvitamin D (25OHD) concentrations have been associated with dementia. The association with mild cognitive impairment (MCI) has not yet been explored. Our aim was to examine the association between vitamin D status and MCI status amongst older community-dwellers with subjective memory complaint. METHODS: Ninety-five non-demented Caucasian community-dwellers with subjective memory complaint (mean, 71.1 ± 6.4 years; 54.7% women) included in the Gait and Alzheimer Interaction Tracking (GAIT) study were categorized into two groups according to Winblad et al. consensus criteria [i.e., subjects with MCI or cognitively healthy individuals (CHI)]. Serum 25OHD concentration was divided into quartiles, the fourth quartile corresponding to the highest 25OHD concentration. The cross-sectional associations between 25OHD concentrations and MCI were modeled using logistic regressions. Age, gender, body mass index, number of comorbidities, education level, Mini-Mental State Examination score, Frontal Assessment Battery score, Geriatric Depression Scale score, creatinine clearance, and season tested were considered as potential confounders. RESULTS: Compared to CHI, patients with MCI (n = 43; mean, 71.4 ± 5.6 years; 34.9% women) had lower mean serum 25OHD concentrations (P = 0.006) and belonged more often to the lower quartiles compared to the highest quartile (P = 0.03). Increased serum 25OHD concentration was associated with a lower risk of MCI [adjusted odds ratio (OR) = 0.96, P = 0.002]. Accordingly, lower quartiles of 25OHD were positively associated with MCI whilst using the highest quartile as reference (adjusted OR = 25.46, P = 0.002 for the first quartile; adjusted OR = 6.89, P = 0.03 for the second quartile; and adjusted OR = 10.29, P = 0.02 for the third quartile). CONCLUSIONS: Low 25OHD concentrations were associated with MCI status in older non-demented community-dwellers with subjective memory complaint.
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Disfunção Cognitiva/sangue , Disfunção Cognitiva/epidemiologia , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia , Vitamina D/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Disfunção Cognitiva/diagnóstico , Estudos Transversais , Feminino , Humanos , Masculino , Deficiência de Vitamina D/diagnósticoRESUMO
Systemic diseases, which are in France mainly monitored in internal medicine, affect multiple organs or tissues. While cutaneous or articular manifestations are the most common, neurological involvement is often associated with severity. Diagnosis of peripheral (e.g, neuropathies) or central (e.g, myelitis) nervous disorders is quite easy through clinical examination and dedicated complementary tests. However, neuropsychological manifestations that affect cognition, including memory, attention, executive functions or reasoning, are difficult to diagnose, sometimes trivialized by practitioners. Their causes are often numerous and interrelated. Nevertheless, these cognitive manifestations are closely related to patients' quality of life, affecting their social life, family dynamics and professional integration but also the treatment adherence. The purpose of this review, focused on the example of systemic lupus erythematosus, is to raise awareness of cognitive dysfunction in systemic diseases including their management from diagnosis to treatments. The final aim is to go further into setting up research groups and care programs for patients with cognitive impairment followed in internal medicine.
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Transtornos Cognitivos , Lúpus Eritematoso Sistêmico , Vasculite Associada ao Lúpus do Sistema Nervoso Central , Cognição , Humanos , Medicina Interna , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/terapia , Testes Neuropsicológicos , Qualidade de VidaRESUMO
OBJECTIVE: To review the clinical and MRI aspects in a series of cases with superficial siderosis of the central nervous system. METHODS: We retrospectively reviewed the patients with imaging evidence of superficial siderosis, investigated in two radiological centers between January 2006 and January 2010. The patients with aneurysms or arterio-venous malformations were excluded from this study. RESULTS: Cortical hemosiderin deposits were present in 25 (0.2%) of the 5904 MRIs with a T2-weighted gradient echo sequence. The classic association bilateral hypoacousia, ataxia and pyramidal signs were rarely found (two cases - 8%). Seven patients (28%) had a bilateral hearing impairment, seven (28%) a cerebellar syndrome and two (8%) a pyramidal syndrome. Sixteen patients (64%) had only supratentorial hemosiderin deposits. A cause of subarachnoid bleeding was identified in 76% of cases: amyloid angiopathy (40%), trauma (16%), cranio-spinal surgery (8%), cavernomas (8%) and brain tumors (4%). CONCLUSION: Superficial siderosis seems to be more frequent than previously thought. The classic clinical triad is rare, although the asymptomatic cases are frequent. A source of subarachnoid bleeding is generally found. Amyloid angiopathy is a frequent etiology of superficial siderosis in elderly patients. In the absence of other causes of subarachnoid bleeding, superficial siderosis may become a magnetic resonance marker for amyloid angiopathy.
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Ataxia/patologia , Encéfalo/patologia , Doenças Cerebelares/patologia , Angiopatia Amiloide Cerebral/patologia , Perda Auditiva Neurossensorial/patologia , Siderose/patologia , Idoso , Idoso de 80 Anos ou mais , Ataxia/complicações , Doenças Cerebelares/complicações , Angiopatia Amiloide Cerebral/complicações , Feminino , Perda Auditiva Neurossensorial/complicações , Hemossiderina/metabolismo , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Siderose/complicaçõesRESUMO
BACKGROUND: Alzheimer's disease and related diseases (ADRD) are a major cause of health-related cost increase. OBJECTIVES: This study aimed to estimate the real medical direct costs of care of patients followed at a memory center, and to investigate potential associations between patients' characteristics and costs. DESIGN: Cross-sectional analyses conducted on matched data between clinical data of a cohort of patients and the claims database of the French Primary Health Insurance Fund. SETTING: Memory center in France. PARTICIPANTS: Patients attending a memory center with subjective cognitive complaint. MEASUREMENTS: Medical or nonmedical direct costs (transportation) reimbursed by the French health insurance during the one year after the first memory visit, and socio-demographic, clinical, cognitive, functional, and behavioral characteristics were analyzed. RESULTS: Among 2,746 patients (mean ± SD age 79.9 ± 8 years, 42.4% of patients with dementia), the total direct cost was on average 9,885 per patient during the year after the first memory visit: 7,897 for patients with subjective cognitive complaint, 9,600 for patients with MCI, and 11,505 for patients with dementia. A higher functional and cognitive impairment, greater behavioral disorders, and a higher caregiver burden were independently associated with a higher total direct cost. A one-point decrease in the Instrumental Activities of Daily Living score was associated with a 1,211 cost increase. The cost was higher in patients with Parkinson's disease, and Lewy body disease compared to patients with AD. Diabetes mellitus, anxiety disorders and number of drugs were also significantly associated with greater costs. CONCLUSIONS: Higher real medical direct costs were independently associated with cognitive, functional, and behavioral impairment, diabetes mellitus, anxiety disorders, number of drugs, etiologies as well as caregiver burden in patients attending a memory center. The identification of factors associated to higher direct costs of care offers additional direct targets to evaluate how interventions conducted in patients with NCD impact direct costs of care.
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Doença de Alzheimer , Instituições de Assistência Ambulatorial , Disfunção Cognitiva , Efeitos Psicossociais da Doença , Gastos em Saúde , Atividades Cotidianas , Idoso , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/economia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/economia , Estudos Transversais , Feminino , França , Humanos , Masculino , Doença de Parkinson/economiaRESUMO
PURPOSE: The objective of this study was to objectivize if the cardiovascular therapeutic changes performed during hospitalization of older patients with hypertension and/or heart failure (HF), were maintained in ambulatory 3 month after hospitalization. METHODS: This is a longitudinal study conducted in a geriatric unit. Patients over 65 years with hypertension and/or HF, who had at least one change in cardiovascular medicaton during hospitalization, and who accepted the 3-month follow-up were included in the longitudinal study. At admission, during hospitalization and 3 months after hospitalization data concerning cardiovascular medication were collected. RESULTS: During hospitalization, 142 (73.6%) patients had at least one change in hypertension and/or HF medication. Overall, 249 changes were performed. Forty-one patients received follow-up at 3 months. At 3 months, therapeutic changes were maintained by 48.8% of the general practitioners (n=20 patients). For the rest, 41.5% of the patients had benefited from new therapeutic changes (28 changes for 10 patients) and 9.7% of the general practitioners (n=4 patients) had restored the initial prescription before hospitalization. CONCLUSIONS: Medication review performed by geriatricians and pharmacists during hospitalization resulted in 249 changes. These changes aimed at limiting iatrogenic disease, by reducing overtreatment and potentially inappropriate prescriptions. Difficulties in the patient care continuity between the hospital and ambulatory setting have been identified.
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Assistência Ambulatorial , Continuidade da Assistência ao Paciente , Insuficiência Cardíaca/tratamento farmacológico , Hospitalização , Hipertensão/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Substituição de Medicamentos/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Feminino , Seguimentos , Avaliação Geriátrica , Humanos , Doença Iatrogênica/prevenção & controle , Prescrição Inadequada/prevenção & controle , Estudos Longitudinais , Masculino , Uso Excessivo dos Serviços de Saúde/prevenção & controle , Estudos Prospectivos , Suspensão de TratamentoRESUMO
White matter hyperintensities (WMH), also known as leukoaraïosis are very common neuroradiological manifestations in the elderly. The main risk factors for WMH are age and high blood pressure. The vascular origin of these lesions is classically accepted and WMH are considered as one feature of the small vessel disease. WMH may be associated with clinical symptoms, depending notably on their importance according to age. They are associated with increased mortality, strokes and changes in cognition with a higher risk of dementia (vascular dementia or Alzheimer's disease). Modification of vascular risk factors could have a beneficial effect, but few evidences from controlled trials are available.
Assuntos
Envelhecimento/fisiologia , Transtornos Cognitivos/etiologia , Leucoaraiose , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/patologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/prevenção & controle , Humanos , Leucoaraiose/complicações , Leucoaraiose/diagnóstico , Leucoaraiose/patologia , Leucoaraiose/prevenção & controle , Substância Branca/diagnóstico por imagem , Substância Branca/patologiaRESUMO
INTRODUCTION: Posterior cortical atrophy (PCA) is a clinically and radiologically defined syndrome, in which predominant symptoms focus on higher visual dysfunction with progressive course and association with cortical atrophy or hypometabolism that predominates in the posterior part of the hemispheres. Homonymous hemianopia (HH) has rarely been described in this syndrome. METHODS: We report on six patients (four females, two males, aged 63 to 80) referred for visual disorder which led to demonstration of HH using perimetry testing. These patients were followed for 1 to 5 years after discovery of HH. Brain imaging with MRI or CT scan was obtained in the six cases and a SPECT scan was performed in four cases. RESULTS: HH was left-sided in four cases and right-sided in two cases. Associated symptoms related to higher visual dysfunction were simultagnosia, alone or as part of a full Balint's syndrome, alexia, constructional apraxia, dressing apraxia, visual form agnosia, prosopagnosia and hemispatial neglect. These symptoms were mild at onset but invariably worsened with disease progression. Dementia eventually developed in all cases. The clinical diagnosis was probable Alzheimer's disease in five cases and corticobasal degeneration in one case. Radiology showed posterior cortex atrophy in all cases as well as reduced cerebral blood flow in the same region, with an asymmetrical pattern compatible with the side of HH. CONCLUSION: Elementary cortical lesions in PCA can develop mainly in the associative visual areas and even in the primary visual area, resulting in HH. HH has rarely been documented in PCA, but its prevalence would probably be higher if systematic search was conducted. Apparently isolated HH of insidious onset should suggest PCA and lead to neuropsychological testing and search for discrete atrophic changes of the posterior cortex on MRI as well as for metabolic alterations with SPECT or PET.