ABSTRACT
BACKGROUND: CSF Alzheimer's disease (AD) biomarkers allow classifying individuals based on their levels of amyloid and neurodegeneration pathologies. OBJECTIVE: To investigate the distribution of AD biomarker profiles from patients suffering from cognitive disorders. METHODS: We analyzed 3001 patients with cognitive disorders and referred by 18 French memory clinics located in and around Paris. Patients were classified as normal, amyloidosis (A+/N-), amyloidosis and neurodegeneration (A+/N+) or suspected non-AD pathophysiology (SNAP), according to their CSF levels of biomarkers. Analysis were performed for the overall population and stratified by gender, age quintiles, and Mini-Mental State Examination (MMSE) score quintiles. Results were compared to previous findings in cohorts of healthy elderly adults. RESULTS: 37% of the sample were classified as A+/N+, 22% were classified A+/N-, and 15% as SNAP. The A+/N+ profile was associated with female gender, advanced age, and lower MMSE score, while the A+/N-profile was observed more frequently in men and the distribution was stable across age and MMSE. The SNAP profile showed no association with gender or age, was less frequent in patients with lower MMSE, and had a lower repartition than the one previously reported in asymptomatic populations. CONCLUSIONS: While A+/N+ patients had the clinical characteristics typically observed in AD, A+/N-patients had a different epidemiological pattern (higher frequency in men, no association with advanced age or lower MMSE). The SNAP profile was less frequent than previously reported in the general elderly population, suggesting that this profile is not a frequent cause of memory impairment in this population.
Subject(s)
Biomarkers/cerebrospinal fluid , Cognition Disorders/cerebrospinal fluid , Aged , Aged, 80 and over , Amyloid beta-Peptides/cerebrospinal fluid , Amyloidosis/cerebrospinal fluid , Disease Progression , Female , France , Humans , Longitudinal Studies , Male , Middle Aged , tau Proteins/cerebrospinal fluidABSTRACT
Influenza is a well established cause of seasonal hospitalizations and deaths among older persons. However, influenza is frequently underdiagnosed by physicians, because its clinical presentations are often complex, particularly in elderly patients. We report the case of a 78-year-old woman admitted to the emergency department in January 2008 with fever, vomiting, and a history of asthenia and falls in the preceding three days. Diagnosis of influenza at admission was missed. Influenza was diagnosed by direct fluorescent antibody in a sputum specimen four days later, but the evolution was rapidly unfavorable with fatal respiratory distress syndrome. This case illustrates that, during the influenza season, influenza should be suspected in elderly patients admitted to hospital even if they do not present with classical symptoms. Immunofluorescence testing on sputum specimens can provide a rapid diagnosis and merits further evaluation.
ABSTRACT
OBJECTIVES: To assess the proportion of lower respiratory tract infections (LRTI) attributable to influenza virus and respiratory syncytial virus (RSV) during the 2005-2006 winter period, among hospitalized elderly in a geriatric unit of a French hospital near Paris and and describe the characteristics of these infections. METHODS: In a geriatric unit with 115 beds, distributed as 14 in acute care (ACF), 21 in rehabilitation and intermediate-care (RICF) and 80 in long-term-care-facilities (LTCF), all patients over age 65 with LRTI were enrolled during a winter. Clinical and biological parameters were recorded including paired serology for influenza virus and RSV. RESULTS: 54 LRTI concerned 47 patients were recorded. 50 paired serums were analysed. Influenza virus or RSV were found in 17 cases (34%). The distribution of the cases was as follows: Influenza A in 5 cases, Influenza B in 3 cases, a co-infection with influenza A and B in 4 cases, RSV in 3 cases and co-infections with influenza and RSV in 2 cases (influenza A and RSV in one case and influenza A and B and RSV in the other case). 7 cases concerned patients in ACF, in 3 cases patients were in RICF and in 7 cases patients were in LTCF. 15 cases were nosocomial infections. 11 patients infected by influenza virus were vaccined. It was concluded as bronchitis in 8 cases, interstitial pneumonia in 6 cases and alveolar pneumonia in 3 cases. Antibiotics were prescribed in 11 cases. In one case the evolution was unfavourable with death. Patients with influenza or RSV infections had significantly more rales and rhonchi compared with patients non infected by these virus (p<0.05). CONCLUSION: Influenza and RSV are an important cause of LRTI in elderly during the winter months, influenza infections can occurring among vaccinated elderly. It seems necessary to achieve further clinical studies about LRTI in elderly and to study the impact of rapid diagnostic tests to improve the management of these infections.