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The existence of alpha-1 antitrypsin variants with apparently unremarkable phenotypes and serum concentrations, contrasting with a clinical picture suggestive of a severe deficiency, led us to investigate whether in these cases there was a reduction or even suppression of the capacity of alpha-1 antitrypsin to inhibit elastase. To this end, in two different laboratories, we adapted and validated a method for measuring the functional activity of alpha-1 antitrypsin, based on spectrophotometric kinetic analysis of the inhibition by serum alpha-1 antitrypsin of the hydrolytic activity of porcine pancreatic elastase on a chromogenic substrate. This method has proved to be robust, reproducible and transferable and made possible to define, on the basis of an analysis of a hospital population, a functionality index with a confidence interval comprised between 0.87 and 1.2, allowing to identify subjects likely to have a functional deficiency of alpha-1 antitrypsin, whether this deficiency being of a genetic origin without any quantitative or phenotypic translation, or whether being acquired under the effect of external agents (cigarette smoke or viruses).
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The recognition of caregivers working with elderly people with neuro-evolutionary diseases is a fact. The caregivers interviewed for this study reported that they felt recognized and identified by these elderly people, who were considered to be prosopagnosic. The caregivers were even able to show that this recognition was possible, even during changes in appearance.
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Cuidadores , Humanos , Cuidadores/psicología , Anciano , Masculino , Femenino , Trastornos Neurocognitivos/enfermería , Trastornos Neurocognitivos/psicología , Persona de Mediana Edad , Anciano de 80 o más AñosRESUMEN
The first orientation test for proteinuria typing is electrophoresis. However, this technique has several drawbacks, such as delayed turnaround time and subjective readings. Some laboratories therefore use quantitative assays of glomerular markers combined with tubular markers. However, the cost of reagents and the instability of certain markers are significant drawbacks for some peripheral laboratories. The aim of this study is to evaluate the implementation of an algorithm based on parameters that can be used by all laboratories for proteinuria typing within a timeframe compatible with the urgency of the situation. Albuminuria and urinary IgG were determined on 161 urines. ROC curves were produced, using urine electrophoresis read by an expert center as the reference method. The decision thresholds used are: glomerular proteinuria is defined by a Albumin+IgGproteinsratio greater than 75.4% (100% specificity), and tubular or overload proteinuria is defined by by a Albuminproteinsratio less than 37.3% (100% sensitivity). Agreement between the results of the algorithm selected and the reference method used in our study was 88 %, with a kappa value of 0.807 (95% CI [0.729 to 0.885]). The algorithm's performance suggests that it can find its place in the diagnostic strategy for clinically significant proteinuria, despite its limited indications. It is up to each biologist to assess the value of this algorithm in relation to the recruitment, habits and needs of clinicians.
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Albuminuria , Algoritmos , Inmunoglobulina G , Proteinuria , Humanos , Albuminuria/diagnóstico , Albuminuria/orina , Proteinuria/diagnóstico , Proteinuria/orina , Masculino , Femenino , Inmunoglobulina G/orina , Persona de Mediana Edad , Adulto , Anciano , Glomérulos Renales , Urinálisis/métodos , Urinálisis/normas , Adulto Joven , Sensibilidad y Especificidad , Anciano de 80 o más Años , Adolescente , Biomarcadores/orinaRESUMEN
Our aim is to explore the possible emergence of traumatic symptoms and the identity-related repercussions of the restrictions on elderly, who entered into nursing homes during the Covid-19 health crisis in France. Twenty-five subjects institutionalised before the health crisis and twenty-six subjects institutionalised during the periods of lockdown into nursing homes completed scales assessing anxiety-depressive symptomatology, traumatic symptoms and identity. Anxiety and depression symptoms were similar between the groups. The institutionalised group showed a significantly higher prevalence of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria D and E on the Post traumatic Stress Disorder Checklist version DSM-5 (PCL-5) during lockdown. Entry into an institution during the health crisis would have favored the emergence of traumatic symptoms in the participants. Consideration of the ethical issues raised by this study could make it possible to offer more individualised support to elderly during their transition to a new home.
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COVID-19 , Anciano , Humanos , Control de Enfermedades Transmisibles , Casas de Salud , Instituciones de Cuidados Especializados de Enfermería , Ansiedad/epidemiologíaRESUMEN
La qualité des soins apportés aux personnes vivant avec la maladie d'Alzheimer (MA) dépend en partie de la capacité des professionnels à déterminer le degré de conscience de la maladie chez les patients. La présente recherche s'est intéressée aux représentations des soignants concernant la conscience des troubles chez les résidents d'établissements de soins de longue durée présentant un diagnostic de MA. Le pouvoir prédicteur de l'anosognosie sur le fardeau soignant a également été examiné. L'anosognosie des troubles de la construction (r = 0,40, p = 0,0164) et de l'initiation (r = 0,32, p = 0,052) était corrélée au fardeau soignant. Les professionnels se représentaient les résidents comme ayant une conscience altérée de leurs capacités, même en l'absence d'anosognosie. Les scores réels d'anosognosie ne prédisaient pas les estimations soignantes, hormis le score global sous forme de tendance (χ2 = 3,38, p = 0,066). Les soignants surestimaient pourtant les performances cognitives des résidents, telles que mesurées au moyen du protocole Misawareness (prédictions aidants/performances réelles : DC = 12,32, p < 0,0001).
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Little research has examined changes in personal identity over different periods of adult development. The aim of the present cross-sectional study was to target these changes through the characterization of the main dimensions in self-defining memories (SDMs; thematic content, specificity, integrative meaning, tension, contamination/redemption, and emotion) and their interactions. Our final sample was composed of 652 healthy French adults aged from 18 to 97 years, divided into four age groups: young adults (n = 163, M = 23.7 years), middle-aged adults (n = 135, M = 44.0 years), young-old adults (n = 178, M = 64.5 years), and old-old adults (n = 176, M = 79.6 years). Participants were asked to recollect three SDMs. A similar pattern of thematic content was observed throughout adulthood, except for relationship narratives were more frequent in the two younger groups. The findings highlighted that specific and integrated SDMs decreased with age and that tension and contaminative sequences were the most frequent in young adults. Redemptive memories did not significantly differ whatever the age of participants. No clear positivity effect was observed with aging. Finally, an analysis of the correlations among the main SDMs' dimensions showed that specificity correlated positively with tension in young adults and integrative meaning with redemption in young and middle-aged participants. We found no significant correlation between specificity and integration in any age group. For the first time, this study sheds new light on lifelong identity adjustments. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Memoria Episódica , Persona de Mediana Edad , Adulto Joven , Humanos , Adulto , Estudios Transversales , Recuerdo Mental , Emociones , Envejecimiento , AutoimagenRESUMEN
The aim of this descriptive study was to investigate the Self-Defining Memories (SDMs) in a large sample of 181 older adults (65-90 years; mean age = 73.0 years) and to target the relationships between their different dimensions. The sampling method was nonprobabilistic, based on voluntary participation. Participants were asked to recall three SDMs. They also completed the Mini-Mental State Examination, the Hospital Anxiety and Depression Scale, and a Self-esteem Scale. Almost half of the SDMs were specific and more than a quarter were integrated. Specificity, tension, redemption, contamination sequences, and affective response varied regarding thematic content. Specificity was positively correlated to tension whereas autobiographical reasoning was positively correlated to redemption and negatively linked to emotional response and depression. This research highlighted that identity is constituted by the main types of events that make up a life: interpersonal relationships, life-threatening events, achievement, and leisure.
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Memoria Episódica , Humanos , Anciano , Emociones , Recuerdo Mental/fisiología , AutoimagenRESUMEN
In the absence of legal provisions, passive physical restraint methods in geriatrics were defined at the start of this century, accompanied by recommendations relating to their use. Despite the frequency of these measures of restraint, there are few French publications on this subject. It seems that this practice varies according to the geriatric establishments and prevails in hospital more than in nursing home. The most widespread method is the dual barrier on the bed, as well as in hospital than in nursing home. To this should be added restraint provided by the premises themselves, intended to secure access to a facility, found in 90% of residences for the dependent elderly, and also medication. Passive physical restraint, mainly implemented to prevent falls, has however clearly shown its deleterious effects, particularly in the USA where it is thought to be responsible for 1/1000 deaths in nursing homes, although when it is absent there appears to be no increased risk of falls. Medication-based restraint is more readily used to sedate in case of disruptive behaviors (agitation, aggressiveness) although no clear data is available to date. Restraint provided by the premises themselves, used preventively in case of wandering and straying, is nevertheless a deprivation of freedom, and seems to concern the majority of geriatric facilities today. In the absence of legislation to regulate these practices, the present authors discuss the need for ethical reflection before the implementation of measures of restraint, whatever their nature, and they propose certain ideas on possible methods for passive physical restraint: raising awareness among caregivers and family members who often call for these measures, the existence of alternative measures, and the delaying of implementation as long as possible and/or sequentially.
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Alpha1-antitrypsin deficiency (AATD) is a rare autosomal recessive disease associated with the homozygous Z variant of the SERPINA1 gene. Clinical expression of AATD, reported 60 years ago associate a severe deficiency, pulmonary emphysema and/or liver fibrosis. Pulmonary emphysema is due to the severe alpha1-antitrypsin deficiency of the ZZ homozygous status and is favored by smoking. Liver fibrosis is due to the ZZ homozygous status and is favored by obesity and excessive chronic alcohol intake, with a risk of liver cancer. Diagnosis is based on serum level and either isoelectric focusing determination of the biochemical phenotype or PCR detection of some variants. SERPINA1 gene sequencing is necessary in case of discrepancies between the results of these tests. No treatment is available for the liver disease in AATD. Although no specific trial has been performed, COPD in AATD should be treated as per COPD recommendations. Based on a randomized clinical trial, augmentation therapy is indicated in non-smoking adults less than 70 years of age with emphysema at chest CT, confirmed homozygous AATD, and FEV1 between 35% and 70% of predicted. In contrast Z heterozygosis (MZ or SZ) brings a risk of lung or liver disease only in association with further risk factors. Early detection, in all patients with COPD and chronic liver disease, is critical for the correct information of Z variant carriers. News ways of correcting the liver production of alpha1-antitrypsin will modify the care of AATD patients.
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An European Alliance of Associations for Rheumatology task force recently recommended specific points to consider for exploring type I interferon pathway in patients, highlighting the lack of analytical assays validated for clinical routine. We report here the French experience on a type I interferon pathway assay that has been set up and used routinely since 2018 in Lyon, France.
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Interferón Tipo I , Reumatología , Humanos , FranciaRESUMEN
OBJECTIVES: The main objective of this study was to determine the directions of the relationships between apathy, cognitive deficits and lack of awareness. METHODS: One hundred and twenty-one older persons living in nursing homes, aged between 65 and 99 years old, participated in the study. Cognitive functioning, autonomy, depressive and anxious symptoms, general self-efficacy, self-esteem and apathy were evaluated through tests and questionnaires. Lack of awareness was calculated using the patient-caregiver discrepancy method. The sample was divided into two groups (n1 = 60, n2 = 61) depending on cognitive functioning level (Dementia Rating Scale < median score: 120). We first explored the characteristics of each group. Then, we compared the mode of evaluation of apathy. Finally, we investigated the direction of relationships by applying mediation analyses. RESULTS: Older persons in the low cognitive functioning group were less autonomous, had a lower cognitive functioning level, higher caregiver-rated apathy and higher lack of awareness than the high cognitive functioning group (ps < 0.05). Evaluation differences were found only in the low cognition group. Caregiver-rated apathy totally mediated the relationship between cognitive functioning (predictor) and lack of awareness (dependent variable) for the whole sample (90%) and for the low cognitive functioning group (100%). CONCLUSIONS: Cognitive deficits should be taken into account when evaluating apathy. Interventions should combine cognition training and emotion intervention to reduce lack of awareness. Future research should develop a therapy dedicated to apathy among older persons without pathologies.
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Apatía , Trastornos del Conocimiento , Disfunción Cognitiva , Humanos , Anciano , Anciano de 80 o más Años , Cognición , Disfunción Cognitiva/psicología , Trastornos del Conocimiento/psicología , Cuidadores/psicologíaRESUMEN
Impaired awareness increases dependency of patients suffering from Alzheimer's Disease (AD) and caregivers' burden but remains insufficiently evaluated in clinical practice. The numerous conceptualisations of this symptomatology (anosognosia, denial, insight ) have only a slight impact on the three main assessment methodologies which are: the patient-caregiver discrepancy; the clinician rating of patients' awareness of illness; and the prediction of performance discrepancy methods. Nevertheless, most of evaluating tools are not validated yet, in particular regarding the clinician rating, leading to contrasted results. Most of recent studies reported positive correlations with apathy and AD severity, and negative relationships with depressive symptoms. Therefore, impaired awareness seems to be mainly influenced by patient's depression and apathy. We discuss these correlates and shared aspects of apathy and impaired awareness from neuroanatomical, clinical and conceptual viewpoints. We also highlight the relevance and limits of quantitative and qualitative assessment methods, in particular phenomenological.
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Agnosia , Enfermedad de Alzheimer , Humanos , Enfermedad de Alzheimer/complicaciones , Enfermedad de Alzheimer/diagnóstico , Depresión/diagnóstico , Pruebas Neuropsicológicas , Cuidadores , Agnosia/diagnóstico , Agnosia/etiologíaRESUMEN
BACKGROUND: Self-defining future projections (SDFP) are mental representations of plausible and highly significant future events that provide core information of one's understanding of self. OBJECTIVE: We explored SDFPs in a large sample of older adults and aimed to target the interrelations between the main dimensions of SDFPs. Moreover, correlations between these dimensions and clinical and cognitive variables were examined. METHODS: We recruited 87 young-old adults (60-75 years) with normal cognitive functioning who were asked to generate three SDFPs. RESULTS: We found integrative meaning as a salient dimension and older individuals preferentially generated projections containing leisure or relationship events. Anxiety and self-esteem were correlated with integrative meaning and high executive functioning was found to be protective towards the simulation of future events containing dependence and death or end-of-life events. CONCLUSION: This study will contribute to the understanding of personal goals and identity in normal ageing.
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Envejecimiento , Función Ejecutiva , Humanos , Anciano , Ansiedad , Cognición , AutoimagenRESUMEN
The current investigation examined the self-concept and temporality in institutionalized and non-institutionalized elderly. Sixty-two participants divided into two groups according to their place of residence participated in the study. The analysis focused on psychopathological scales, on self-concept assessment, its positive or negative valence, its development and the time perspective. The results showed that the institutionalized group was defined more with descriptive evaluations, emotional states, and peripheral information. The non-institutionalized group described themselves more with traits and specific attributes. For some identity statements, the emotional valence between the two groups was significantly different. The institutionalized group is not turned towards a particular temporal perspective, unlike the non-institutionalized who is more forward-looking. Findings suggest that there are differences in self-expression and temporality in our sample. This exploratory study emphasizes the importance of taking into account the self of institutionalized elderly and the temporality in which they are projected upon entering an institution.
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Introduction: Following the Covid-19 epidemic affecting 76 of the 97 residents (78.3 %) in a French nursing home, we assessed the impact of this cluster period on the physical and psycho-cognitive health of the residents, expecting in particular to observe effects that were dependent on their state of cognitive-behavioural dependence. Methods: We retained twenty-two variables, 5 relating to demographic data, 6 to the specific care linked to Covid-19 infection, 6 to somatic pathologies and psycho-behavioural disturbances before the epidemic and 5 to the period following it. Results: Eleven residents among those diagnosed positive died. Nine were transferred to a Covid unit, and 35 were asymptomatic. The main consequences of the period of infections were in particular behavioural, nutritional, and motor. A history of disruptive behaviours before the appearance of the cluster increased the risk of an aggravation of these behaviours by four (RR = 3.9, IC95 % = 1.3811.02, p = 0.0042). Twenty per cent of the residents presented under-nutrition at the end of lockdown, but no specific risk factors could be identified. However, states of under-nutrition for the whole of 2020 were significantly more frequent than in 2019, in particular severe cases (χ² = 5.43, p = 0.02). A history of under-nutrition in the previous year increased twofold the likelihood of under-nutrition in the following year (RR = 2.07, IC95 % = 1.143.74, p = 0.02). The Covid cluster period also had an effect on the functional autonomy of certain patients. Conclusion: Our main hypothesis relating to cognitive-behavioural dependence was not completely validated. The impact of the occurrence of the cluster remained moderate, in particular because of the care resources afforded by the nursing home. The advantages of a "medicalised" facility, and the problems associated with the restrictions of lockdown, are viewed in the light of ethical considerations.
Introduction: Suite à une épidémie de Covid-19 ayant affecté 76 des 97 résidents d'un Ehpad, nous avons évalué l'impact de cette période de cluster sur la santé physique et psycho-cognitive des résidents pronostiquant notamment une altération en fonction de leur dépendance cognitivo-comportementale. Méthodes: Nous avons retenus vingt-deux variables relatives : aux données démographiques (5) ; aux prises en charge spécifiques liées à l'infection (6) ; aux pathologies somatiques et troubles psycho-comportementaux avant l'épidémie (6) et après la période de cluster (5). Résultats: Onze résidents diagnostiqués positifs sont décédés. Neuf ont été transférés en unité Covid et 35 étaient asymptomatiques. Les troubles consécutifs à la période de cluster concernaient la majoration des comportements perturbateurs et la dénutrition lorsque des antécédents existaient déjà (respectivement : RR = 3,9, IC95 % = 1,3811,02, p = 0,0042 ; RR = 2,07, IC95 % = 1,143,74, p = 0,02), ainsi que la réduction des capacités motrices. Nous n'avons pu objectiver d'autres facteurs explicatifs spécifiques à ces altérations. Conclusion: Notre hypothèse principale en lien avec la dépendance cognitivo-comportementale n'apparaît pas totalement validée. L'impact de la période de cluster est resté modéré notamment grâce aux moyens médico-soignants dont l'Ehpad disposait. L'avantage d'un dispositif médicalisé et l'inconvénient des restrictions liées au confinement est discuté au regard de questions éthiques.
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COVID-19 , Desnutrición , COVID-19/epidemiología , Control de Enfermedades Transmisibles , Humanos , Casas de Salud , Estado NutricionalRESUMEN
Previous studies have reported the major role of apathy in awareness assessment among Alzheimer's patients using the patient-caregiver discrepancy method, whatever the awareness dimension assessed. Using the Apathy Evaluation Scales among other awareness scales, we report that apathy is the sole awareness dimension distinguishing healthy controls (25), mild (57) and moderate-to-moderately-severe (11) Alzheimer's patients. A linear regression showed that the Mini-Mental State Examination score used as a risk factor for non-awareness was the only factor associated with awareness of apathy and was the best predictor. This suggests that apathy is the most discriminant dimension for awareness assessment in Alzheimer's disease.
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Enfermedad de Alzheimer , Apatía , Enfermedad de Alzheimer/diagnóstico por imagen , Cuidadores , HumanosRESUMEN
Nostalgia is an efficient coping strategy that helps elders overcome major life transitions. To better explore the protective functions of nostalgia, we set out to adapt a short-form nostalgia scale to French elders and examine its convergent and divergent validity in terms of self-esteem, depression, and wellbeing. Participants were 175 institutionalized French elders. After providing their written informed consent, they were asked to complete a demographic information form and respond to four questionnaires probing self-esteem, nostalgia, depression, and wellbeing. Principal component analyses and fit indices were used to explore convergent validity. An 8-item version showed acceptable psychometric properties and measured two dimensions of nostalgia. Spearman correlations were conducted to explore divergent validity. In our sample, the first dimension was negatively associated with global cognitive functioning, while the second dimension was positively associated with self-esteem and wellbeing, and negatively associated with depression. The negative relationship between depression and nostalgia supports the idea that nostalgia is a positive concept. Future research should explore factors liable to impact nostalgia, such as cultural differences and reminiscence therapy.
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Adaptación Psicológica , Autoimagen , Anciano , Humanos , Psicometría , Reproducibilidad de los Resultados , Encuestas y CuestionariosRESUMEN
To date, few studies have focused on the impact of anosognosia on patients' and caregivers' daily lives. However, in more general studies, anosognosia has been linked to increased burden of family caregivers, refusals to receive care, and increased caregivers' psycho-behavioral disorders. However, these studies did not specify the nature of the impact of anosognosia on these manifestations, often attributed to cognitive impairment which is more representative of the disease. The aim of this review is to provide an overview of the current knowledge of the impact of anosognosia on the patient-caregiver relationship and to identify possible future directions to lessening its consequences.
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Agnosia , Disfunción Cognitiva , Demencia , Cuidadores , HumanosRESUMEN
OBJECTIVES: Impairment of type I interferon (IFN-I) immunity has been reported in critically ill COVID-19 patients. This defect can be explained in a subset of patients by the presence of circulating autoantibodies (auto-Abs) against IFN-I. We set out to improve the detection and the quantification of IFN-I auto-Abs in a cohort of critically ill COVID-19 patients, in order to better evaluate the prevalence of these Abs as the pandemic progresses, and how they correlate with the clinical course of the disease. METHODS: The concentration of anti-IFN-α2 Abs was determined in the serum of 84 critically ill COVID-19 patients who were admitted to ICU in Hospices Civils de Lyon, France, using a commercially available kit (Thermo Fisher, Catalog #BMS217). RESULTS: A total of 21 of 84 (25%) critically ill COVID-19 patients had circulating anti-IFN-α2 Abs above cut-off (> 34 ng mL-1). Among them, 15 of 21 had Abs with neutralising activity against IFN-α2, that is 15 of 84 (18%) critically ill patients. In addition, we noticed an impairment of the IFN-I response in the majority of patients with neutralising anti-IFN-α2 Abs. There was no significant difference in the clinical characteristics or outcome of with or without neutralising anti-IFN-α2 auto-Abs. We detected anti-IFN-α2 auto-Abs in COVID-19 patients' sera throughout their ICU stay. Finally, we also found auto-Abs against multiple subtypes of IFN-I including IFN-ω. CONCLUSIONS: We reported that 18% of critically ill COVID-19 patients were positive for IFN-I auto-Abs, whereas all mild COVID-19 patients were negative, confirming that the presence of these antibodies is associated with a higher risk of developing a critical COVID-19 form.
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Torque Teno Virus (TTV) is a small, non-enveloped, single-stranded and circular DNA virus that infects the majority of the population worldwide. Increased levels of plasma TTV viral load have been observed in various situations of immune deficiency or dysregulation, and several studies have suggested that TTV levels may be inversely correlated with immune competence. The measurement of TTV viremia by qPCR has been proposed as a potential biomarker for the follow-up of functional immune competence in immunosuppressed individuals, particularly hematopoietic stem cell transplant recipients. We hypothesized that TTV viral load could be used as a prognostic marker of immune checkpoint inhibitor (ICI) efficacy, and therefore investigated the TTV viral load in melanoma patients treated with nivolumab or pembrolizumab before and after 6 months of treatment. In the present study, TTV viral load was not different in melanoma patients before anti-PD-1 introduction compared to healthy volunteers, was not modified by ICI treatment and did not allowed to distinguish patients with treatment-sensitive tumor from patients with treatment-resistant tumor.