Tele-ophthalmology for screening for eye diseases in older patients with cognitive complaints.

INTRODUCTION: Population-based studies show a significant increase in the prevalence of visual impairment in older patients. However, older patients and patients with lower Mini-Mental State Examination (MMSE) scores have few ophthalmological assessments. The main objective of our study was to evaluate the feasibility of tele-ophthalmological screening for ophthalmological diseases in older patients referred for cognitive assessment. METHODS: This monocentric prospective study included patients referred to a memory clinic for cognitive assessment. All patients underwent a geriatric assessment comprising a cognitive assessment associated with tele-ophthalmological screening undertaken by an orthoptist, including undilated retinal photography. The retinal photographs were subsequently sent to an ophthalmologist. We identified patients who were not eligible for ophthalmological assessment, for patients that had to come back due to poor-quality retinal photographs and finally for detected eye diseases. The association between the geriatric variable and newly detected eye diseases was analysed in univariable and multivariable analyses. RESULTS: The mean age of the 298 patients included was 83.5 years ± 5.65; 29.5% were male. The mean MMSE score was 20.8 ± 5.2; 66.3% of patients had a diagnosis of dementia. Eighteen patients (6.0%) were not eligible for ophthalmological examination and 13 patients (4.6%) were asked to come back owing to poor-quality retinal photographs. Forty-one patients (13.7%) had a newly detected eye disease. In multivariable analysis, patients with a lower MMSE had significantly more newly identified eye diseases. DISCUSSION: The tele-ophthalmological screening method identified unknown ophthalmological diseases requiring specialised management in this older population with cognitive complaints.

Association between comorbidity burden and rapid cognitive decline in individuals with mild to moderate Alzheimer's disease.

OBJECTIVES: To determine the association between rapid cognitive decline and burden of comorbidities as assessed using the Charlson Comorbidity Index in individuals aged 65 and older with Alzheimer's disease (AD). DESIGN: Retrospective cohort study. SETTING: Memory clinic at the University Hospital of Nantes. PARTICIPANTS: Individuals aged 65 and older with AD (n=170). MEASUREMENTS: Subjects were followed for 1 year. Rapid cognitive decline was defined as a decrease of 3 or more points on the Mini-Mental State Examination per 12-month period. Variables studied were the Charlson Comorbidity Index (measure of comorbidity burden), age, sex, AD stage, type of residence (living at home or not), presence of caregiver, functional abilities (Lawton and Katz scales), risk of malnutrition or depression, and intercurrent events (hospitalization or initiating home care). RESULTS: Rapid cognitive decline at 1-year follow-up occurred in 65 subjects (38.2%). In fully adjusted logistic regression analysis, Charlson Comorbidity Index was significantly associated with rapid cognitive decline (odds ratio (OR)=1.30, P=.03). Moderate stage of AD (OR=2.07, P=.04) and living at home (OR=4.17, P=.04) were also associated with rapid cognitive decline. CONCLUSION: Comorbidity burden was associated with rapid cognitive decline in subjects with AD.

[Arterial stiffness a new risk factor to measure]. / La rigidité artérielle, un nouveau facteur de risque à mesurer.

We revue the epidemiology of cardiovascular disease in the elderly, their relationship to arterial stiffness. The measurement of arterial stiffness is of considerable increasing interest in this early 21 century. This paper is focusing on modeling, in different measurement methods. Several measurement techniques are presented. A review of the bibliography that explain the link between cardiovascular risk factors and arterial stiffness is summarized, as are the relationships between the various risk factors and arterial stiffness. The current role of these measurement methods seems to be time consuming although the European consensus recommends the measure once a year in the management of vascular patients. New techniques for the assessment of the arterial stiffness, more reproducible and easy to use, could ultimately trivialize this measurement, contributing in medical practice to the assessment and the management of the vascular risk.

[Nutrition and osteoporosis in elderly]. / Nutrition et ostéoporose chez le sujet âgé

Osteoporosis concerns 50% of women over 80 years. Prevalence of energizing and protein malnutrition is high as for institutional elderly people as for community dwelling elderly people. Malnutrition, physical inactivity and many etiological factors lead to tissular losses especially on protein compartment, named sarcopenia. Among the common etiological factors, some cytokines have an effect on proteolysis and bone restructuring, interfering with osteoclast metabolism. Inflammation or stress, mechanisms which product cytokines, are responsible for unfavourable bone restructuring and for a loss of protein mass, deteriorating the muscular functional prognostic. We researched articles on Medline® between 1980 and 2010 about relations between protein compartment, malnutrition and bone density. Several studies in literature suggest that increase in protein intake in daily caloric needs could have a positive effect on bone mineral density and functional performances (in primary prevention as in secondary prevention). So, primary and secondary preventive measures must comprise an increase in protein intake and a sufficient physical activity.