Relationship between quality of life and cognitive decline in dementia.

AIMS: We aimed to examine the association of cognitive decline with quality of life (QoL) in dementia compared to controls and to determine variables associated with QoL. METHODS: Every subject was placed within a specific group depending on their designation by the Mini Mental State Examination and evaluated by the Alzheimer's Disease Related Quality of Life (ADRQL) and clinical assessments. RESULTS: QoL for the mild dementia group was lower (p = 0.08) than that of controls. The very severe dementia group had a significantly lower QoL than the other dementia groups, which all had similar ADRQL scores. The only predictor of ADRQL scores was found to be the behavioral and psychological symptoms of dementia. CONCLUSION: There is no direct relationship between cognitive decline and QoL.

[A study of endogenous evoked potentials (P300 and CNV) in retired patients]. / Une étude des potentiels évoqués endogènes (P300, VCN), chez le sujet du troisième âge.

Endogenous evoked potentials of two types (CNV and P300 complexes) as well as their respective reaction times were recorded in 29 elderly, active subjects (15 men and 14 women) between 60 and 84 years of age. Our subjects also passed anxiety, depression and cognitive scales. The different results were then analyzed in relation with each other and in relation with age and sex. No age-related differences were found in the principal elements measured in the P300 complex, but several elements of the CNV complex were clearly shown to be age-sensitive. Sex-related differences were found in the N2 and P3a potentials. CNV morphology (Tecce type A) and cognitive scores were found to be related to Spielberger's anxiety-trait sub-scale. Several results also highlighted the heterogeneity of this age group. The need for complementary studies in this age group is then discussed with the hope that neurophysiology can become a useful tool in psychogeriatrics.

Françoise, a fifteen-year follow up.

A fifteen-year follow up of the linguistic and cognitive profile of a woman, named Françoise, with standard trisomy 21. She had been studied in considerable detail between 1987 and 1991 by Rondal (1995) and found to have exceptionally good language abilities in advance of regular cognitive abilities for a person with Down syndrome. Françoise's psychological functioning has been deteriorating relatively rapidly over the last two years. A severe deterioration of her previously excellent receptive language abilities is documented in the present study. Productively, her on-line word finding is becoming problematic, mean length of utterance has halved compared with 15 years ago, and production of compound sentences is reduced. However, basic phonological and morphosyntactic skills are preserved. Françoise's changing profile during the latter years seems to mirror that documented in the first stages of Alzheimer disease in ageing adults in the general population.

[Does homosexuality have a place in psychopathology? III. Behavioral approach and homosexuality]. / L'homosexualité a-t-elle une place dans la psychopathologie? III. Approche comportementale et homosexualité.

The behavioral approach does not propose any global explaining theory of homosexuality. It was the subject of many clinical and experimental works. Some questions and hypotheses are raised on the theoretical and therapeutical as well as ethical frames. When the behaviorist speaks of homosexuality, he only refers to the mode of behavior, at the object and not to deep characteristics of the individual. The homosexual behavior is defined as resulting from a sexual excitation in the presence of uncommon stimuli. The sexual preference is not considered as the proof of a psychopathological problem. On the etiological ground, the homosexual behavior is resulting from a social learning with a possibility of biological predisposition. The therapeutic approach is controversial. Some authors feel the behaviorist should refuse to help the patient changing his sexual orientation, even if he asks for it.

[Behavior therapy and neurotic behavior]. / Behaviour therapy et comportements névrotiques.

The first part of the lecture presents three classical aspects of behavior therapy: therapeutic efficiency, utilisation of well defined methods, rapidity of treatment. Emphasis is brought to the importance of behavior analysis and to the dangers arisen from insufficient knowledge or ignorance of learning theories and fundamental principles of behavior analysis. One insists on experimental analysis which is the basis for methods of action having as consequence for the therapeut: controlling strategy of treatment and direct responsibility concerning success and failure. Then, actual limitations of behaviour therapy are described. The second part deals with one of the most important working hypothesis on human neurosis originating from laboratory and clinical research. Behavior therapy refuses to elaborate hypothetical deductive constructions, unless working hypotheses to be verified. Then the four essential clues to behavioural psychotherapy are formulated. The main methods of action presently utilized are presented: aversive methods, operational and systematic desensitization technics through reciprocal inhibition. Finally, some of the main criticism usually made on behaviour therapy are being discussed.

[Rehabilitation and the pathology of dementia]. / Revalidation et pathologie démentielle.

To recognize the influence of the social and physical environment on demential pathology has methodological and therapeutical implications. Since the beginning of the seventies, many works have demonstrated that senile deterioration is not a continuous nor insurmountable process. There is no ineluctable evolution, independent of environment. The different therapeutical strategies can be analysed in terms of behavior modification through an action upon the physical and social determinants of the environment. The authors present two complementary methods of revalidation: an individualised reeducation of necessary behaviors for a social autonomy (toilet, dressing, continence) and a program of physical and psychic activation, to maintain or reestablish social skills (management of the institutional environment, physical mobilisation, ergotherapy and sociotherapy). These methods are relevant to the functional analysis and behavior modification. They are in concordance with the goals of the contemporary gerontology.

[Psychogeriatric hospitalization]. / L'hospitalisation psychogériatrique.

A pessimistic view is not acceptable in psychogeriatrics, even in the field of senile dementia. There is a need for specialized psychogeriatric units, allowing a multifocal approach of these patients. This is illustrated by the report of the methodology developed at the Psychogeriatric Center "Le Pérî" (Liège). For 12 years, a multidisciplinary approach has been in use, to precisely evaluate the clinical picture and to properly design a therapeutic strategy for demented patients, in order to improve their residual capacities and, if possible, to discharge them from hospital.

Acute effect of drugs upon memory of patients with senile dementia.

Memory has been tested in senile demented patients with the Rey Auditory Verbal Learning Test. The processus of memorization can be significantly facilitated in acute conditions by lysin-vasopressin, to a lesser degree by piracetam and highly worsened by scopolamine. No effect of physostigmine has been observed.

Double-blind randomized controlled study of phosphatidylserine in senile demented patients.

A double-blind randomized controlled study was conducted in 42 hospitalized demented patients to evaluate the therapeutical effect of phosphatidylserine (BS-PS). Half of the patients received 3 X 100 mg of this product, and the other half a placebo of the same appearance. After a wash-out period, prescription lasted for six weeks. To evaluate the patients, two distinct rating scales were used: the Crichton Scale and an original one (Peri Scale) designed in our geriatric unit (see Appendix). A circle crossing test was added. Out of the 35 patients who completed the trial, 18 had received placebo and 17 BC-PS. The results indicated a trend toward improvement in the BC-PS treated patients and an analysis of covariance showed a significant (p less than 0.05) treatment effect on the Peri Scale. The results at the end of the treatment period were compared with those obtained three weeks later. Here again there was a statistically significant difference in the Peri Scale results, indicating that modifications are drug-related. The behavioral improvement shown in this study is in agreement with experimental studies on aged animals.