Modifiable Risk Factors Associated With Cognitive Decline in Late Life Depression: Findings From the Canadian Longitudinal Study on Aging: Facteurs de risque modifiables associés au déclin cognitif dans la dépression en fin de vie : constatations de l'Étude longitudinale canadienne sur le vieillissement.

OBJECTIVE: Depression in later life is associated with a two-fold increased risk of dementia. It is not clear to what extent potentially modifiable risk factors account for this association. METHOD: Older adults (age 50 + ) with objective health measures (n = 14,014) from the Canadian Longitudinal Study on Aging were followed for a mean duration of 35 months. Linear regression analyses were used to determine if clinically significant depression (Centre for Epidemiologic Studies Depression scale score (CESD) ≥ 10) was associated with global cognitive decline, assessed with a neuropsychological battery during follow-up, and if modifiable risk factors mediated this association. RESULTS: Depression was associated with an excess of risk factors for cognitive decline including: vascular disease, hypertension, diabetes, apnoea during sleep, higher body mass index, smoking, physical inactivity and lack of social participation. In regression analyses depression remained independently associated with cognitive decline over time (beta -0.060, P = 0.038) as did cerebrovascular disease (beta -0.197, P < 0.001), HbA1C (beta -0.059, P < 0.001), visual impairment (beta -0.070, P = 0.007), hearing impairment (beta -0.098, P < 0.001) and physical inactivity (beta -0.075, P = 0.014). In mediation analyses, we found that cerebrovascular disease (z = -3.525, P < 0.001), HbA1C (z = -4.976, P < 0.001) and physical inactivity (z = -3.998, P < 0.001) partially mediated the association between depression and cognitive decline. CONCLUSIONS: In this large sample of Canadian older adults incorporating several objective health measures, older adults with depression were at increased risk of cognitive decline and had an excess of potentially modifiable risk factors. Clinicians should pay particular attention to control of diabetes, physical inactivity and risk factors for cerebrovascular disease in older adults presenting with depression as they can contribute to accelerated cognitive decline and may be addressed during routine clinical care.

Obsessive-compulsive symptoms in dementia: Systematic review with meta-analysis.

Dementia is a highly prevalent syndrome with various causes, characterized by cognitive deficit in one or more domains, with important impairment of functioning, which frequently presents with neuropsychiatric symptoms that may include obsessive-compulsive symptoms. OBJECTIVES: The main goal of this meta-analysis was to describe and determine the prevalence of obsessive-compulsive symptoms in dementia. MATERIALS AND METHODS: To accomplish that, MEDLINE, CENTRAL and Psycnet databases were searched from inception to March 2023. The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data was applied. The principal summary measures were the mean of prevalence of obsessive-compulsive symptoms in patients with dementia and the number of each type of obsession or compulsion. RESULTS: Of the 643 articles screened, 92 were accepted for full-text assessment. Of these, 30 with information on prevalence of obsessive-compulsive symptoms in dementia or any description of those were included, yielding a total of 37 cohorts (5 studies with two cohorts and 1 study with three cohorts). According to our results, obsessive-compulsive symptoms have considerable prevalence in dementia (35.3%, 23.1-47.6%), namely in frontotemporal dementia (48.4%, 29.8-67.0%); obsessive-compulsive symptoms were less frequent in other dementia diagnosis (17.6%, 9.1-26.2%). The more frequent obsessive contents are symmetry (28.6%) and somatic (20.0%); and the more frequent compulsions are checking (27.4%); hoarding is also a relevant symptom (27.8%). DISCUSSION: There was considerable heterogeneity in the prevalence of obsessive-compulsive symptoms in frontotemporal dementia, that is, in part related with diagnostic criteria for dementia, as well as obsessive-compulsive symptom assessment. A careful distinction between compulsions and compulsive-like symptoms is fundamental. Hypervigilance for somatic symptoms and concerns about disease and mortality, as well as deficits in cognitive domains like attention and memory may explain why somatic obsessions and checking compulsions are more prevalent. CONCLUSIONS: The present results indicate that obsessive-compulsive symptoms may be prevalent in the clinical course of many patients with dementia, especially frontotemporal dementia. Better instruments are needed to describe obsessive-compulsive phenomena in a reliable and comparable way, particularly in a population such as dementia patients, whose subjectivity is difficult to access.

[Psychopathology of Lewy body disease: the clinical benefits of early detection]. / Psychopathologie de la maladie à corps de Lewy : intérêts cliniques du repérage précoce.

Despite its high prevalence among neurodegenerative diseases, Lewy body disease (LBD), or Lewy body dementia (LBD), because of its clinical proximity to Alzheimer's and Parkinson's diseases, is often undiagnosed or misdiagnosed. Better identification of this condition, in order to provide better care for sufferers and their carers, is a health objective on which progress is desirable.

[The use of videoconferencing in psychogeriatrics, a pilot experiment]. / L'utilisation de la vidéoconférence en psychogériatrie.

The Alzheimer's plans have led to significant progress in the care management of elderly people suffering from Alzheimer's disease or other forms of dementia, but the medical and social network remains fragmented in geriatrics. We have proposed to caregivers a monthly videoconference combining expert presentations and discussion of clinical cases. Several health professions were represented. The main positive point was the time saved. The videoconferencing improved multidisciplinary exchanges, especially for patients with complex problems and their families.

[Use of new technologies in the diagnosis of neurodegenerative pathologies]. / Utilisation des nouvelles technologies dans le diagnostic des pathologies neurodégénératives.

These last ten years, new technologies are more and more used in therapeutic and rehabilitation programms for patients with dementia, and used for the diagnosis of theses diseases, from the signal treatment. A review of litterature shows this growing interest among the scientific communauty for these new technologies.

[Screening for Alzheimer's disease by assessing memory impairment]. / Dépister la maladie d'Alzheimer en évaluant la plainte mnésique.

The feeling of memory failure is the most frequently expressed discomfort with age. The difficulty is to distinguish between a memory complaint and a memory pathology. Alzheimer's disease is diagnosed at the stage of dementia. Early detection and the prospect of treatments likely to act lead to an interest in its pre-dementia phase, which is known to precede the appearance of the dementia syndrome by several years.

Meclizine ameliorates memory deficits in streptozotocin-induced experimental dementia in mice: role of nuclear pregnane X receptors.

Pregnane X receptors (PXRs) regulate the expression of ATP-binding cassette proteins transporters and organic anion transporting polypeptides responsible for influx/efflux of xenobiotics across the brain. Ligand activation of PXR augments the expression of P-gp and promotes amyloid-ß clearance across the blood-brain barrier. Dementia was induced in mice by intacerebroventricular administration of streptozotocin (STZ) followed by treatment with meclizine, a PXR agonist, and subsequently exposed to the Morris water maze test and biochemical and histopathological analysis to evaluate the effect on cognition. STZ-treated mice exhibited significant enhancement in brain thiobarbituric acid reactive species, interleukin-1ß, tumour necrosis factor-α, myeloperoxidase, and acetylcholinestrase activity in addition to diminution in glutathione levels and superoxide dismutase activity in comparison to untreated mice. Administration of meclizine to STZ mice recuperated cognition and biochemical alterations. Concomitant administration of ketoconazole, a PXR antagonist, with meclizine prevented the protective effects. The upshots of our study proclaim that meclizine protects cognitive deficits by virtue of its antioxidant, anticholinesterase, and antiinflammatory properties. Results also signify the potential of PXR in neuroprotective actions of meclizine in dementia.

[Malignant catatonia in dementia with Lewy Body successfully treated with sismotherapy: A case report]. / Catatonie maligne compliquant une démence à corps de Lewy traitée par électro-convulsivo-thérapie : à propos d'un cas.

Malignant catatonia is a life-threatening syndrome, associated mostly with psychiatric diseases but also with neurological and neurodegenerative syndromes. We report the case of a 72-year-old patient, hospitalized for a major depressive episode with delusional symptoms, who presented a malignant catatonia. The patient had been transferred to an intensive care unit and treated with electroconvulsive therapy (ECT) leading to a rapid disappearance of the catatonic syndrome associated with a remission of the depressive symptoms. Complementary investigations helped us to secondarily diagnose a Lewy Body Dementia, which probably caused, associated with a treatment by haloperidol, the onset of catatonia. This case illustrates the need of an early diagnosis of neurodegenerative diseases in psychiatric outpatients and the importance of a quick management of catatonia, including ECT.

[Urinary tract symptoms in Lewy body dementia: About 19 cases]. / Les troubles urinaires de la maladie à corps de Lewy. À propos de 19 cas.

INTRODUCTION: Lewy Body Dementia (LBD) is a Parkinsonian disorder which often leads to Lower Urinary Tract Symptoms (LUTS), especially an Overactive Bladder (OAB). There have been few LBD related LUTS depictions in the literature, which is why we did this retrospective study. METHODS: Retrospective single institution study. RESULTS: Nineteen patients with confirmed LBD diagnosis were found, (63% of men, mean age 74 years old). The main symptom was OAB (100% of patients) with frequent stress urinary incontinence (94%) associated with detrusor overactivity (93%) with pressure elevation (79%). Voiding difficulties were found in 16% of medical interviews, and in 53% of urodynamics. In total, 92% of patients complained of constipation, with 44% suffering from fecal incontinence. DISCUSSION: LBD is characterized by alpha-synuclein aggregates in the cerebral cortex, thus explaining associated cognitive impairment. The most commonly found LUTS is stress incontinence. We also found voiding difficulties in smaller proportion, sometimes associated with prostatism. Topographically, these symptoms could be explained by alpha-synuclein aggregates in the frontal and temporal cortex and the pons. Anorectal disorder and sexual dysfunction were frequently associated. Urological complications are scarce in this population, screening is focused in increasing quality of life, and the possibility to discriminate the different types of Parkinsonisms. CONCLUSION: OAB is the most common lower urinary tract symptom in LBD often associated with detrusor overactivity, and less frequently voiding difficulties sometimes associated to prostatism. LEVEL OF EVIDENCE: 3.

[Promoting home support for elderly people with neurocognitive disorders: Caregiver perception of the help-seeking process]. / Favoriser le maintien à domicile des personnes âgées atteintes de troubles neurocognitifs. Perception par les proches aidants de leur processus de recherche d'aide.

BACKGROUND: Caregivers play an essential role in maintaining home care for elderly people with dementia. However, it is difficult for caregivers to target their own needs as well as those of the person with neurocognitive disorders they support on a daily basis. Identifying the needed resources can also be difficult. In order to better assist caregivers in identifying resources needed to support their role, this study aims to understand the factors that influence their help-seeking process. METHODS: This qualitative and descriptive study focuses on the point of view of the main people affected by this problem: caregivers. Eleven caregivers of elderly people with dementia living at home were recruited by convenience sampling. Semi-structured interviews were conducted, and the data were analyzed according to Mast's typology. RESULTS: The factors influencing caregivers help-seeking process were categorized into five themes: 1) service-related (e.g. wait times); 2) personal (e.g. feeling intrusive); 3) experiential (e.g. positive use of a service); 4) relational (e.g. rejection of the elder), and 5) informational (e.g. directed to the right service). CONCLUSION: Caregivers face many challenges in their help-seeking process and want to be more proactively accompanied in a way adapted to their changing needs.

Highly integrated workflows for exploring cardiovascular conditions: Exemplars of precision medicine in Alzheimer's disease and aortic dissection.

For precision medicine to be implemented through the lens of in silico technology, it is imperative that biophysical research workflows offer insight into treatments that are specific to a particular illness and to a particular subject. The boundaries of precision medicine can be extended using multiscale, biophysics-centred workflows that consider the fundamental underpinnings of the constituents of cells and tissues and their dynamic environments. Utilising numerical techniques that can capture the broad spectrum of biological flows within complex, deformable and permeable organs and tissues is of paramount importance when considering the core prerequisites of any state-of-the-art precision medicine pipeline. In this work, a succinct breakdown of two precision medicine pipelines developed within two Virtual Physiological Human (VPH) projects are given. The first workflow is targeted on the trajectory of Alzheimer's Disease, and caters for novel hypothesis testing through a multicompartmental poroelastic model which is integrated with a high throughput imaging workflow and subject-specific blood flow variability model. The second workflow gives rise to the patient specific exploration of Aortic Dissections via a multi-scale and compliant model, harnessing imaging, computational fluid-dynamics (CFD) and dynamic boundary conditions. Results relating to the first workflow include some core outputs of the multiporoelastic modelling framework, and the representation of peri-arterial swelling and peri-venous drainage solution fields. The latter solution fields were statistically analysed for a cohort of thirty-five subjects (stratified with respect to disease status, gender and activity level). The second workflow allowed for a better understanding of complex aortic dissection cases utilising both a rigid-wall model informed by minimal and clinically common datasets as well as a moving-wall model informed by rich datasets.

[Ethics and giving bad news to a patient with Alzheimer's]. / Éthique et mauvaise nouvelle à un patient Alzheimer.

Breaking bad news to a patient with Alzheimer's often raises ethical questions: should the person be informed or not when there is a risk he or she will not understand or retain the explanations provided? While on the face of it the truth seems desirable, it is important to carefully analyse what is at stake as this truth can potentially harm a vulnerable patient. The person making the disclosure can find themselves at the centre of a conflict: on the one hand loyalty and a moral duty to inform, on the other a compassionate lie to protect the patient from upsetting news. Being aware of the ethical issues at the heart of this dilemma can help to indicate the best path to take for the benefit of the patient, the family and the nurses.

[Transgressions and Behavioral Disorders in Demented Seniors]. / Transgression et troubles du comportement chez les personnes âgées démentes.

Cognitive disorders of Alzheimer's disease are not the only determinants of the behavioral disorders of the elderly. A transgressive will may be underlying, related to the life story or archaic psychological defense mechanisms. As a result, their human environment is distressed which sometimes aggravates behavioral problems. In institutions, this situation increases the psycho-social risks.

[Agitation and aggression in elderly persons with dementia]. / Agitation et agressivité chez la personne âgée démente.

Managing aggression and agitation in elderly people with dementia can be seen from the perspective of certain conditions. Some therapies, particularly the use of neuroleptics, should be avoided. The need to put limits on non-pharmacological treatments must be emphasised.

[Art therapy in enhanced accommodation units]. / Art-thérapie en unité d'hébergement renforcé.

When cognitive disorders in the elderly are significant, for caregivers there remains the possibility of empathy, relational calm, time needed to help them access their memory, and escape the terrible sensation of not knowing. Entering a closed space dedicated to these seniors means creating contact with people who are lost in the twists and turns of a story they no longer recognise as their own. Feedback from an art-therapy workshop with cognitively fragile seniors, cut off from all references.

[Alzheimer's disease and singing: an application in mediated therapy]. / Chant et démence de type Alzheimer, une application en thérapie médiatisée.

A study was conducted on the implementation and evaluation of a therapeutic device by singing in a protected unit for elderly people with Alzheimer's dementia. This randomised and controlled research consists of an experimental group participating in the therapeutic mediation device by singing, and a group benefiting from conventional care. The results indicate that the therapeutic mediation device of singing significantly promotes emotional expression, self-awareness, and acts on the psycho-behavioural disorders of older subjects.

[Multi-professional Institutional Music Therapy Project]. / Un projet pluriprofessionnel de musicothérapie en Ehpad.

The depletion of memory capacity is a specificity of population within activity and adapted care centres. It would seem, however, that learning abilities can be retained when song is used as mediator. In a multi-professional team, work was developed over eight weeks within an active music therapy group. Given the results, it appears that this hypothesis has been validated.

[Caring for people suffering from Alzheimer's disease]. / Les soins aux personnes souffrant de la maladie d'Alzheimer.

The provision of physical, mental and social care to people with Alzheimer's disease is a major public health challenge. With the awareness of progressive neurological disorders and their consequences, the personal and psychological dimension of each patient must lie at the heart of the care provided throughout the disease's progression. This personalisation can have positive clinical effects while helping to preserve as much as possible the dignity of the people concerned.

Prevalence of toxoplasmosis and its association with dementia in older adults in Central Africa: a result from the EPIDEMCA programme.

OBJECTIVE: We aimed at estimating the seroprevalence of Toxoplasma gondii (T. gondii) infection in older adults living in Central Africa and investigating its association with dementia using data from the Epidemiology of Dementia in Central Africa (EPIDEMCA) programme. METHODS: A cross-sectional multicentre population-based study was carried out among participants aged 73 (±7) years on average, living in rural and urban areas of the Central African Republic and the Republic of Congo between November 2011 and December 2012. Blood samples were collected from each consenting participant. The detection of anti-T. gondii immunoglobulin G antibodies was performed in 2014 in France using a commercially available ELISA kit. Participants were interviewed using a standardised questionnaire including sociodemographic characteristics. DSM-IV criteria were required for a diagnosis of dementia. Multivariate binary logistic regression models were used to assess the association between toxoplasmosis infection and dementia. RESULTS: Among 1662 participants, the seroprevalence of toxoplasmosis was 63.0% (95% confidence interval (CI): 60.7-65.3) overall, 66.6% (95%CI: 63.4-69.8) in Central African Republic and 59.4% (95%CI: 56.1-62.7) in the Republic of Congo. In multivariate analyses, toxoplasmosis status was significantly associated with increasing age (P = 0.006), Republic of Congo (P = 0.002), urban area (P = 0.001) and previous occupation (P = 0.002). No associations between dementia and toxoplasmosis status or anti-T. gondii IgG titres were found. CONCLUSION: Toxoplasma gondii infection was not associated with dementia among older adults in Central Africa. Our findings are consistent with previous studies and add to the knowledge on the relationship between T. gondii infection and neurological disorders.