Background: Alzheimer’s disease (AD) is a neurodegenerative pathology that disrupts processing of... more Background: Alzheimer’s disease (AD) is a neurodegenerative pathology that disrupts processing of facial expressions of emotion. The impairment was demonstrated for negative emotions in tasks of matching, discriminating, and labeling facial expressions but no study has included the expression of pain in its protocol. Objective: The objective was to study the processing of emotional facial expressions in AD with a particular interest in pain expression. Methods: Twenty-seven controls, 15 mild AD patients, and 15 moderate AD patients had to perform four emotional tasks: identification of facial expressions, matching pain expressions, discriminating the intensity of pain expressions, and judging pain intensity. Results: Some emotions were less efficiently recognized by AD patients compared to controls (p < 0.001), specifically fear from the mild stage (p < 0.05), pain and disgust from the moderate stage (p < 0.05 and p < 0.001 respectively). The Exploratory Factor Analy...
Chronic pain (CP) was associated with impaired cognitive performance in several cross-sectional s... more Chronic pain (CP) was associated with impaired cognitive performance in several cross-sectional studies conducted in older adults; however, fewer longitudinal studies assessed this link which remains still debated. With a prospective design, the present analysis was aimed at evaluating the relationship between CP and the change in several tests assessing memory, attention, verbal fluency and processing speed. The study population was selected from the PAQUID study, a cohort of community dwellers aged 65 and over; 693 subjects receiving a pain assessment were included. CP was evaluated using a questionnaire administered at 3-year follow-up. Cognitive performances were assessed every 2-3 years between 3 and 15 years assessing general cognition (MMSE), verbal and visual memory (word paired associate test and Benton test) attention and speed processing (Wechsler DSST, Zazzo's cancellation task) language skills and executive functions (Isaacs set test). The link between CP and the change in cognitive function was assessed with latent process mixed models controlled for age, gender, education, comorbidities, depression and analgesic drugs. The association between CP and each of the cognitive scores was then tested with the same procedure. A significant relationship was observed between CP and poorer 15-year scores on global cognitive performance (p=0.004), and specifically DSST (p=0.002) associated with a higher slope of decline (p=0.02). CP is associated with higher cognitive decline, in particular in processing speed. This result reinforces the importance of actively treating CP with pharmacological and non-pharmacological strategies to prevent its consequences, including cognitive consequences.
Background: Neuroticism is recognized as the personality domain that is most strongly associated ... more Background: Neuroticism is recognized as the personality domain that is most strongly associated with behavioral and psychological symptoms (BPS) of Alzheimer's disease (AD). Two sub-components of neuroticism have been recently isolated. Neuroticism-withdrawal (N-withdrawal) refers to the tendency to internalize negative emotion, whereas neuroticism-volatility (N-volatility) reflect the predisposition to externalize negative emotions. Objective: The objective of the current study was to investigate the specific influence of these two sub-components of neuroticism on BPS. Methods: One hundred eighty-seven patients with prodromal or mild AD were drawn from the PACO study (Personalité Alzheimer COmportement). Neuroticism and its facets were assessed at baseline using the NEO-PI-R inventory. N-withdrawal and N-volatility were isolated using a principal component analysis led on the six facets composing neuroticism. BPS were measured with the short version of Neuropsychiatric Inventory (NPI-Q) and collected at baseline, then every 6 months over an 18-month follow-up. Linear mixed-effect analyses were conducted to investigate the association between N-withdrawal, N-volatility, and the severity of BPS over the follow-up. Results: Mean age of the participant was 79.2 ± 6.5; 59% were female; mean MMSE was 24.5 ± 2.5. Both N-volatility and N-withdrawal were related with the NPI-Q (p < 0.001; p = 0,004). N-withdrawal was positively associated with anxiety (p = 0.001) and depression (p = 0.002), while N-volatility was positively related to delusions (p = 0.004), agitation/aggression (p < 0.001), irritability/volatility (p = 0.037), and apathy (p = 0.021). Conclusion: The present study demonstrates that N-volatility and N-withdrawal influence the risk of developing BPS in a different way. These results highlight the relevance of considering sub-components of neuroticism when studying links between personality and BPS.
Background: Among non-pharmacological therapies, musical intervention is often used for patients ... more Background: Among non-pharmacological therapies, musical intervention is often used for patients with Alzheimer's disease (AD) and patients presenting chronic pain. However, their efficacy is still under debate. Objective: Our aim was to determine the efficacy of choral singing versus painting sessions on chronic pain, mood, quality of life, and cognition in AD patients. Methods: In this multicenter randomized controlled trial, 59 mild AD patients were randomized to a 12-week singing (SG; n = 31) or painting group (PG; n = 28). Chronic pain, anxiety, depression, and quality of life were assessed before, after, and 1 month after the sessions. Cognitive abilities were assessed before and after interventions. The evolution of these different
The 2008-2012 French Alzheimer's Plan has provided hospital Cognitive and Behavioral Units (C... more The 2008-2012 French Alzheimer's Plan has provided hospital Cognitive and Behavioral Units (CBU) to improve the management of patients with productive behavioral and psychological symptoms of dementia (BPSD). Little is known concerning the behavioral outcome of these patients after discharge. The present study investigated the long-term evolution of BPSD over one year after CBU discharge. The EVITAL cohort included 221 participants admitted to the CBUs of 3 French hospitals. BPSD were collected using the Neuropsychiatric Inventory (NPI) at admission and 3, 6, and 12 months after hospitalization. The global NPI score evolution was assessed using a linear mixed-effect model. A four-factor model of the NPI including behavioral dyscontrol, psychosis, mood, and agitation subscores was also analyzed. Our analysis focused on 148 patients followed up during 12 months and evaluated at each visit. The global NPI score was 48.5 (SD 21.7) at baseline, 28.8 (SD 18.7) at 3-month, 23.2 (SD 16....
L'etude PAQUID (QUID sur les Personnes Agees) a debute en 1988 avec pour objectif principal l... more L'etude PAQUID (QUID sur les Personnes Agees) a debute en 1988 avec pour objectif principal l'etude du vieillissement cerebral et fonctionnel. Un echantillon de 3777 personnes âgees vivant a leur domicile dans 75 communes de Gironde et Dordogne a ete enquete au domicile et fait depuis l'objet d'un suivi. Le but de cet article est de presenter une synthese des principaux resultats obtenus recemment. L'incidence de la demence est beaucoup plus elevee chez les femmes que chez les hommes apres 75 ans. Des facteurs de risque de demence ont ete mis en evidence : niveau d'etudes, celibat, alimentation. La plainte mnesique doit etre prise en consideration lorsqu'elle amene a consulter. Le retentissement de la deterioration cognitive se fait deja sentir 3 a 5 ans avant le diagnostic de demence par des incapacites aux activites instrumentales de la vie courante : utiliser le telephone, utiliser les moyens de transport, etre responsable de la prise de ses medicaments ou gerer son budget. Ces perturbations correspondraient a une alteration des processus controles a la phase pre-clinique de la maladie. A un stade plus avance la demence entraine une incapacite aux activites de base de la vie courante: 57,8 % des beneficiaires potentiels de la PSD sont des dements. La grille AGGIR manque neanmoins de sensibilite pour apprehender les besoins en aide des dements, puisque la moitie des dements ne sont pas classes GIR 1, 2 ou 3.
tion, we did not find that the IPA-model HMO program (Evercare) described in our article required... more tion, we did not find that the IPA-model HMO program (Evercare) described in our article required greater physician participation than the other three staffor group-model HMOs. We believe that the level of physician participation is based on the type of patient served (postacute vs subacute vs custodial) and not the type of HMO. We agree with many of the other comments, most of which make comparisons between their program and the programs we presented.
Psychologie & neuropsychiatrie du vieillissement, 2006
The phenomenology of Behavioral and Psychological Symptoms of Dementia (BPSD) occurring in the Al... more The phenomenology of Behavioral and Psychological Symptoms of Dementia (BPSD) occurring in the Alzheimer's disease and related syndromes remains not well known. The goal of this study was to assess the role of disorders of personality, psychiatric disorders and home environment in the occurence of the BPSD; 99 inpatients from a short-term Alzheimer unit were included in the study. BPSD were assessed by the NeuroPsychiatric Inventory, the severity of dementia by the MMSE. Previous somatic, psychiatric and personality disorders were evaluated by a semi-structured interview of the family, and classified according to the A, B and C groups from the DSM-IV. Eighty eight percent of the patients presented at least one BPSD. The patients whose the main caregiver was a spouse appeared to be more aggressive. Sixty seven per cent of the patients presented with former disorders of personality; they were more delirious, more anxious, more irritable and suffered more disorders of appetite. Eac...
ABSTRACT Context Alzheimer&#39;s disease and associated disorders (ADAD) are increasing due t... more ABSTRACT Context Alzheimer&#39;s disease and associated disorders (ADAD) are increasing due to the ageing of the population. These pathologies have a significant impact on the patient but also on his/her family. The caregivers’ daily involvement has indeed consequences on their health but it also creates a disruption of their personal and professional lives. Optimal care taking of patients with ADAD therefore requires a real consideration of the caregiver&#39;s suffering. In the department of the Rhone, funding by the Caisse nationale solidaire pour l’autonomie and the “Conseil général” as created a platform specifically intended to these natural caregivers, Rhône + caregivers (R + A). Objective The objective of the present study was to estimate the relevance and the importance of R + A device in the Alzheimer&#39;s chain, but also to define areas of improvement at the end of three years of experimentation. Method Twenty-five caregivers responded to questionnaires administered by telephone and semi-directive interviews were conducted with 17 professionals in contact with the platform. Results The profile of surveyed caregivers corresponds to the literature data. It reflects the late arrival of caregivers within the platform. Indeed, the majority of the patients (64%) were at an advanced stage of the disease. The objectives of the structure are consistent with caregivers’ and professionals’ expectations. Eighty percent of caregivers found that the R + A has met their expectations and 100% would recommend it to their environment and perceived it as useful for society. Caregivers and professionals are satisfied with the actions and practical elements of R + A. They emphasize its usefulness and its relevance in the territory. The proposed improvements mainly concern the monitoring of patients and feedback to professionals. Conclusion This study underlines the importance of the existence of such a structure in the department. The results encourage its development and extension.
ABSTRACT Context Alzheimer&#39;s and related disorders are characterized by an impairment of ... more ABSTRACT Context Alzheimer&#39;s and related disorders are characterized by an impairment of cognitive functions and Behavioral and Psychological Symptoms of Dementia (BPSD). These symptoms are unpredictable and can lead to crises. In this context, cognitive-behavioral units (CBUs) have been created. Their aim is to stabilize behavioural disorders through rehabilitation programs. Objective The objective of this survey was to better understand the functioning of CBUs in the Rhône-Alpes region one year after their implementation. Method A questionnaire was administered to CBUs teams. The questionnaire included five items: patients, structure, CBUs teams, therapy, admission and orientation. Results Among the 8 CBUs contacted, 7 agreed to receive us. The responses show that the primary objectives are met as the structures accommodate patients presenting Alzheimer&#39;s disease and related disorders with BPSD and reduced behavioural problems through the institution of appropriate care. The average active file of CBUs was 91 patients, mean age 81.9 years, for a number of beds between 10 and 14. Sixty-seven percent of patients were coming from home with, in 66 % of cases, Alzheimer&#39;s disease (Mini-Mental Status average 12.3). The average length of stay was 36.4 days. The average Neuro-Psychiatric Inventory (NPI) on entry was 38.62 against 21.12 at the outlet. Conclusion Despite the differences observed between the CBUs, the survey shows common reflections and problems among them. It shows the interest for the CBUs to belong to a continuum of care.
Introduction La maladie d’Alzheimer est une maladie complexe avec un retentissement physique et p... more Introduction La maladie d’Alzheimer est une maladie complexe avec un retentissement physique et psychique sur le patient et son entourage. Ainsi, la prise en charge necessite l’intervention d’une equipe pluridisciplinaire pour proposer le projet de soin le plus adapte. Methodologie Au sein du CHU de Saint-etienne, nous avons cree une filiere de soins Alzheimer integrant plusieurs maillons : - consultations memoire - hopital de jour (depuis 1986) - service d’hospitalisation complete de neuro-psychogeriatrie, (depuis 2003). Les demandes emanant du pavillon d’urgence augmentent (patients hospitalises sous contrainte, patients errants dans les rues, refus de consultation, refus de suivi…). Aussi avons-nous voulu completer ces propositions de soins par la creation d’une equipe mobile : l’Unite de Prise en charge Extrahospitaliere de la precarite Cognitive (UPEPC) ; composee d’un medecin geriatre, d’une psychologue et d’une secretaire (a mi-temps depuis janvier 2009.) qui se deplace au domicile des patients presentant des troubles cognitifs et psychocomportementaux. Les objectifs sont d’anticiper les situations de crise et de proposer une alternative en cas de rupture de soins. Resultats de 4 mois de fonctionnement 52 visites a domiciles ont permis de faire une evaluation cognitive et psychologique de 36 patients en refus total de soins ; 47% des signalements ont ete effectue par les medecins traitants, 42% les medecins du CHU. 42% de refus d’aides a domiciles ; 16% refus de consultations memoire ; 16% refus d’hospitalisation et 42% troubles psychocomportementaux. L’echelle de Zarit retrouve un chiffre moyen de 41. Le MMS moyen etait de 19 /30 ; 42% des patients avaient eu un diagnostic neurologique etabli ; L’equipe de l’UPEPC a pu permettre d’eviter l’hospitalisation en urgence de ces 36 patients : 75% d’entre eux ont pu etre integres dans la filiere de soins (42% d’hospitalisations programmees et 56% maintenus a domicile). Conclusions Le deni des troubles et la resistance du patient (diagnostic, suivi, acceptation d’aides, separation avec le domicile) bloquent toute possibilite d’alliance therapeutique et ne peuvent, dans certains cas, que se gerer a domicile, veritable enjeu du suivi.
Cognitive-behavioral units (CBUs) have been created in the context of the national Alzheimer plan... more Cognitive-behavioral units (CBUs) have been created in the context of the national Alzheimer plan 2008/2012 for the management of behavioral disorders of patients suffering from Alzheimer&amp;amp;#39;s disease or related diseases. The Alzheimer plan promotes the evaluation of these units through the observation of the evolution of behavioral and psychological symptoms of dementia (BPSD). The aim of this study was to assess the effects of the memory center of Lyon (hospices civils de Lyon) CBU on BPSD. The neuropsychiatric inventory (NPI) was rated by the patients&amp;amp;#39; caregiver (NPI-F) at admission to the CBU and 2 weeks after the discharge. The NPI was also rated by the nursing staff (NPI-NS) 3 days after admission in the CBU and at discharge. All patients admitted in the CBU between July and October 2001 were included in the study for a total of 28 patients. A significant reduction of NPI-F scores between admission (58.93 ± 24.8) and 2 weeks after the discharge (27.07 ± 19.70) (P&amp;amp;lt;0.0001) was observed. Improvement was specifically observed for delusions, agitation, depression, anxiety, disinhibition and aberrant motor activity symptoms. No significant changes were found on NPI-NS scores. This study discloses benefits of CBUs in terms of BPSD reduction in patients 2 weeks after CBU discharge. These units have the potential to achieve their principal objective of reducing behavioral problems.
Introduction Notre enquete a porte sur une cohorte de personnes âgees suivies depuis 2001 pour de... more Introduction Notre enquete a porte sur une cohorte de personnes âgees suivies depuis 2001 pour determiner si le maintien des capacites cognitives chez de jeunes retraites vivant a domicile pouvait predire un vieillissement reussi quelques annees plus tard. Methodes 988 questionnaires ont ete envoyes aux sujets de la cohorte PROOF. Le vieillissement reussi a ete defini selon la notion de bien-etre a travers un score global d’etat de sante percu (“Comment percevez-vous votre etat de sante?”) et un score global de satisfaction (“Etes-vous en general satisfait de votre vie actuelle ?), mesures par des Echelles Visuelles Analogiques (EVA) graduees de 0 a 10. Les capacites cognitives avaient ete evaluees 6 ans plus tot selon une approche objective (epreuve de rappel libre/rappel indice (RL/RI) a 16 items, test de Benton et test des similitudes de la WAIS-3) et une approche subjective (EVA pour evaluer la plainte mnesique, echelle d’anxiete de Goldberg et echelle de Mac Nair). Resultats 686 questionnaires ont pu etre analyses. La moyenne d’âge des sujets etait de 72.9 ans +/-1,2 et on retrouvait 59.2% de femmes. 99% des personnes vivaient a domicile ; 24.5% vivaient seules. Parmi ceux qui avaient travaille, le nombre moyen d’annees de retraite etait de 13.7 ans +/- 4.1. Les personnes âgees vivant seules avaient un plus mauvais score d’etat de sante percu (p=0.0254) et de satisfaction (p Conclusion Le maintien des capacites cognitives chez de jeunes retraites vivant a domicile est un facteur predictif de vieillissement reussi autopercu 6 ans plus tard.
EUROQUEST was designed to explore various neuropsychiatric symptoms caused by neurotoxic agents i... more EUROQUEST was designed to explore various neuropsychiatric symptoms caused by neurotoxic agents in occupational epidemiological studies. This paper was aimed at assessing (i) the internal consistency of the French version of EUROQUEST, (ii) its sensitivity to age, educational level and exposure, (iii) and its convergent validity by examining relationships between declared symptoms and results from psychometric tests on the same mental functions. Data from four cross-sectional studies were selected: 180 workers exposed to toluene, mixed solvents or anaesthetic gas, and 588 non-exposed ones. The internal consistency of the questionnaire was assessed by computing Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alphas. Sensitivity to age, educational level and exposure were assessed with multiple linear regression models. Relationships between EUROQUEST scores and correspondent neuropsychological tests were assessed with Pearson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s correlation coefficients. The relationships between EUROQUEST domain specific scores, age and educational level were evaluated for men and women from the Reference group. Most of the analyses were performed in men and women separately. The results of the Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alphas computed for each EUROQUEST domain, showed a reasonable internal consistency for the questionnaire. For both women and men, memory problems and sleep disorders increased significantly with age. A significant association between EUROQUEST scores and exposure to neurotoxic agents was found for workers exposed to anaesthetic gas only. In addition, EUROQUEST memory symptoms from the Reference population were found to be correlated with two memory neuropsychological tests, both for men and women. Our results showed a high internal consistency and a good convergent validity on assessed domains. Moreover, they showed a significant sensitivity to age, educational level and highlighted sensitivity to anaesthetic gas exposure.
This study examined the short-term relationships between the work conditions during the day prece... more This study examined the short-term relationships between the work conditions during the day preceding the data collection, including working hours, subsequent sleep and cognitive efficiency. The study also addressed the issue of whether this relationship differed as a function of age. The data were taken from the cross-sectional phase of the VISAT study (Aging, Health, and Work, Marquié et al., 2002). The sample included 3237 wage earners from both genders, aged from 32 years to 62 years old at the time of the first measurement, and working in a wide range of jobs. The data included detailed information on present and past working conditions, sleep and health. It also included an assessment of cognitive efficiency (immediate and delayed memory, speed, and attention). Preliminary results based on multiple regression analyses showed that working before 6 a.m. or after 10 p.m. on the previous day was significantly associated with poorer cognitive efficiency, even after adjustment for gender and educational level, and after statistical control of factors such as sleep duration, perceived sleep quality, and other work characteristics of the previous day. No interaction was found between age and working hours, thus indicating that the observed effects of an atypical work schedule during the previous day on cognitive performance was similar for all ages (additive effect).
Previous studies have assessed the relationship between subjective cognitive complaints and objec... more Previous studies have assessed the relationship between subjective cognitive complaints and objective impairment. While some of them found that cognitive complaints were explained by affective disorders, other researches found a relationship between cognitive complaints and neuropsychological performance. Most of them focused on memory functioning. However, elderly normal adults also display a decline in executive functions. This study aimed to assess the relationship between cognitive complaints, objective memory and executive performance and affective disorders. This study was carried out with 937 community-dwelling elderly individuals recruited from the electoral list of the city of Saint-Etienne, France. Cognitive complaints were assessed using the MacNair scale. Cognitive performances were measured via a large battery of memory and executive-performance tests chosen for their capacity to detect subtle cognitive impairment. Anxiety and depressive symptoms were assessed using scales devised by Pichot and Goldberg. Cognitive complaints were associated with lower scores on verbal-memory tests and several executive-performance tests. Moreover, affective disorders were related to some of the executive-performance test scores, but they were not related to scores on the Free and Cued Selective Reminding Test, Digit Symbol Substitution Test and Trail Making B scores. Cognitive complaints of the elderly can reflect objective memory and executive-performance impairments, independent of affective disorders. Cognitive complaints should be assessed using both memory and executive-performance tests.
Elderly subjects diagnosed with mild cognitive impairment (MCI) are becoming the target of interv... more Elderly subjects diagnosed with mild cognitive impairment (MCI) are becoming the target of intervention trials. The criteria used for MCI are principally issued from prospective clinical studies, although longitudinal population-based studies having identified several cognitive predictors of dementia can be of great contribution in the definition of these criteria. This study was conducted to explore the external validity of MCI criteria issued from a longitudinal population-based study, and subsequently to identify the best predictors of the short-term conversion to Alzheimer’s disease 2 years after the MCI diagnosis. Ninety elderly volunteers with memory complaint diagnosed with MCI on the basis of their functional and neuropsychological performances were followed up within 2 years. The potential predictors of the conversion to dementia collected at baseline included age, gender, educational level, size of temporal lobe, apolipoprotein E genotype and a series of neuropsychological...
Background: Alzheimer’s disease (AD) is a neurodegenerative pathology that disrupts processing of... more Background: Alzheimer’s disease (AD) is a neurodegenerative pathology that disrupts processing of facial expressions of emotion. The impairment was demonstrated for negative emotions in tasks of matching, discriminating, and labeling facial expressions but no study has included the expression of pain in its protocol. Objective: The objective was to study the processing of emotional facial expressions in AD with a particular interest in pain expression. Methods: Twenty-seven controls, 15 mild AD patients, and 15 moderate AD patients had to perform four emotional tasks: identification of facial expressions, matching pain expressions, discriminating the intensity of pain expressions, and judging pain intensity. Results: Some emotions were less efficiently recognized by AD patients compared to controls (p < 0.001), specifically fear from the mild stage (p < 0.05), pain and disgust from the moderate stage (p < 0.05 and p < 0.001 respectively). The Exploratory Factor Analy...
Chronic pain (CP) was associated with impaired cognitive performance in several cross-sectional s... more Chronic pain (CP) was associated with impaired cognitive performance in several cross-sectional studies conducted in older adults; however, fewer longitudinal studies assessed this link which remains still debated. With a prospective design, the present analysis was aimed at evaluating the relationship between CP and the change in several tests assessing memory, attention, verbal fluency and processing speed. The study population was selected from the PAQUID study, a cohort of community dwellers aged 65 and over; 693 subjects receiving a pain assessment were included. CP was evaluated using a questionnaire administered at 3-year follow-up. Cognitive performances were assessed every 2-3 years between 3 and 15 years assessing general cognition (MMSE), verbal and visual memory (word paired associate test and Benton test) attention and speed processing (Wechsler DSST, Zazzo's cancellation task) language skills and executive functions (Isaacs set test). The link between CP and the change in cognitive function was assessed with latent process mixed models controlled for age, gender, education, comorbidities, depression and analgesic drugs. The association between CP and each of the cognitive scores was then tested with the same procedure. A significant relationship was observed between CP and poorer 15-year scores on global cognitive performance (p=0.004), and specifically DSST (p=0.002) associated with a higher slope of decline (p=0.02). CP is associated with higher cognitive decline, in particular in processing speed. This result reinforces the importance of actively treating CP with pharmacological and non-pharmacological strategies to prevent its consequences, including cognitive consequences.
Background: Neuroticism is recognized as the personality domain that is most strongly associated ... more Background: Neuroticism is recognized as the personality domain that is most strongly associated with behavioral and psychological symptoms (BPS) of Alzheimer's disease (AD). Two sub-components of neuroticism have been recently isolated. Neuroticism-withdrawal (N-withdrawal) refers to the tendency to internalize negative emotion, whereas neuroticism-volatility (N-volatility) reflect the predisposition to externalize negative emotions. Objective: The objective of the current study was to investigate the specific influence of these two sub-components of neuroticism on BPS. Methods: One hundred eighty-seven patients with prodromal or mild AD were drawn from the PACO study (Personalité Alzheimer COmportement). Neuroticism and its facets were assessed at baseline using the NEO-PI-R inventory. N-withdrawal and N-volatility were isolated using a principal component analysis led on the six facets composing neuroticism. BPS were measured with the short version of Neuropsychiatric Inventory (NPI-Q) and collected at baseline, then every 6 months over an 18-month follow-up. Linear mixed-effect analyses were conducted to investigate the association between N-withdrawal, N-volatility, and the severity of BPS over the follow-up. Results: Mean age of the participant was 79.2 ± 6.5; 59% were female; mean MMSE was 24.5 ± 2.5. Both N-volatility and N-withdrawal were related with the NPI-Q (p < 0.001; p = 0,004). N-withdrawal was positively associated with anxiety (p = 0.001) and depression (p = 0.002), while N-volatility was positively related to delusions (p = 0.004), agitation/aggression (p < 0.001), irritability/volatility (p = 0.037), and apathy (p = 0.021). Conclusion: The present study demonstrates that N-volatility and N-withdrawal influence the risk of developing BPS in a different way. These results highlight the relevance of considering sub-components of neuroticism when studying links between personality and BPS.
Background: Among non-pharmacological therapies, musical intervention is often used for patients ... more Background: Among non-pharmacological therapies, musical intervention is often used for patients with Alzheimer's disease (AD) and patients presenting chronic pain. However, their efficacy is still under debate. Objective: Our aim was to determine the efficacy of choral singing versus painting sessions on chronic pain, mood, quality of life, and cognition in AD patients. Methods: In this multicenter randomized controlled trial, 59 mild AD patients were randomized to a 12-week singing (SG; n = 31) or painting group (PG; n = 28). Chronic pain, anxiety, depression, and quality of life were assessed before, after, and 1 month after the sessions. Cognitive abilities were assessed before and after interventions. The evolution of these different
The 2008-2012 French Alzheimer's Plan has provided hospital Cognitive and Behavioral Units (C... more The 2008-2012 French Alzheimer's Plan has provided hospital Cognitive and Behavioral Units (CBU) to improve the management of patients with productive behavioral and psychological symptoms of dementia (BPSD). Little is known concerning the behavioral outcome of these patients after discharge. The present study investigated the long-term evolution of BPSD over one year after CBU discharge. The EVITAL cohort included 221 participants admitted to the CBUs of 3 French hospitals. BPSD were collected using the Neuropsychiatric Inventory (NPI) at admission and 3, 6, and 12 months after hospitalization. The global NPI score evolution was assessed using a linear mixed-effect model. A four-factor model of the NPI including behavioral dyscontrol, psychosis, mood, and agitation subscores was also analyzed. Our analysis focused on 148 patients followed up during 12 months and evaluated at each visit. The global NPI score was 48.5 (SD 21.7) at baseline, 28.8 (SD 18.7) at 3-month, 23.2 (SD 16....
L'etude PAQUID (QUID sur les Personnes Agees) a debute en 1988 avec pour objectif principal l... more L'etude PAQUID (QUID sur les Personnes Agees) a debute en 1988 avec pour objectif principal l'etude du vieillissement cerebral et fonctionnel. Un echantillon de 3777 personnes âgees vivant a leur domicile dans 75 communes de Gironde et Dordogne a ete enquete au domicile et fait depuis l'objet d'un suivi. Le but de cet article est de presenter une synthese des principaux resultats obtenus recemment. L'incidence de la demence est beaucoup plus elevee chez les femmes que chez les hommes apres 75 ans. Des facteurs de risque de demence ont ete mis en evidence : niveau d'etudes, celibat, alimentation. La plainte mnesique doit etre prise en consideration lorsqu'elle amene a consulter. Le retentissement de la deterioration cognitive se fait deja sentir 3 a 5 ans avant le diagnostic de demence par des incapacites aux activites instrumentales de la vie courante : utiliser le telephone, utiliser les moyens de transport, etre responsable de la prise de ses medicaments ou gerer son budget. Ces perturbations correspondraient a une alteration des processus controles a la phase pre-clinique de la maladie. A un stade plus avance la demence entraine une incapacite aux activites de base de la vie courante: 57,8 % des beneficiaires potentiels de la PSD sont des dements. La grille AGGIR manque neanmoins de sensibilite pour apprehender les besoins en aide des dements, puisque la moitie des dements ne sont pas classes GIR 1, 2 ou 3.
tion, we did not find that the IPA-model HMO program (Evercare) described in our article required... more tion, we did not find that the IPA-model HMO program (Evercare) described in our article required greater physician participation than the other three staffor group-model HMOs. We believe that the level of physician participation is based on the type of patient served (postacute vs subacute vs custodial) and not the type of HMO. We agree with many of the other comments, most of which make comparisons between their program and the programs we presented.
Psychologie & neuropsychiatrie du vieillissement, 2006
The phenomenology of Behavioral and Psychological Symptoms of Dementia (BPSD) occurring in the Al... more The phenomenology of Behavioral and Psychological Symptoms of Dementia (BPSD) occurring in the Alzheimer's disease and related syndromes remains not well known. The goal of this study was to assess the role of disorders of personality, psychiatric disorders and home environment in the occurence of the BPSD; 99 inpatients from a short-term Alzheimer unit were included in the study. BPSD were assessed by the NeuroPsychiatric Inventory, the severity of dementia by the MMSE. Previous somatic, psychiatric and personality disorders were evaluated by a semi-structured interview of the family, and classified according to the A, B and C groups from the DSM-IV. Eighty eight percent of the patients presented at least one BPSD. The patients whose the main caregiver was a spouse appeared to be more aggressive. Sixty seven per cent of the patients presented with former disorders of personality; they were more delirious, more anxious, more irritable and suffered more disorders of appetite. Eac...
ABSTRACT Context Alzheimer&#39;s disease and associated disorders (ADAD) are increasing due t... more ABSTRACT Context Alzheimer&#39;s disease and associated disorders (ADAD) are increasing due to the ageing of the population. These pathologies have a significant impact on the patient but also on his/her family. The caregivers’ daily involvement has indeed consequences on their health but it also creates a disruption of their personal and professional lives. Optimal care taking of patients with ADAD therefore requires a real consideration of the caregiver&#39;s suffering. In the department of the Rhone, funding by the Caisse nationale solidaire pour l’autonomie and the “Conseil général” as created a platform specifically intended to these natural caregivers, Rhône + caregivers (R + A). Objective The objective of the present study was to estimate the relevance and the importance of R + A device in the Alzheimer&#39;s chain, but also to define areas of improvement at the end of three years of experimentation. Method Twenty-five caregivers responded to questionnaires administered by telephone and semi-directive interviews were conducted with 17 professionals in contact with the platform. Results The profile of surveyed caregivers corresponds to the literature data. It reflects the late arrival of caregivers within the platform. Indeed, the majority of the patients (64%) were at an advanced stage of the disease. The objectives of the structure are consistent with caregivers’ and professionals’ expectations. Eighty percent of caregivers found that the R + A has met their expectations and 100% would recommend it to their environment and perceived it as useful for society. Caregivers and professionals are satisfied with the actions and practical elements of R + A. They emphasize its usefulness and its relevance in the territory. The proposed improvements mainly concern the monitoring of patients and feedback to professionals. Conclusion This study underlines the importance of the existence of such a structure in the department. The results encourage its development and extension.
ABSTRACT Context Alzheimer&#39;s and related disorders are characterized by an impairment of ... more ABSTRACT Context Alzheimer&#39;s and related disorders are characterized by an impairment of cognitive functions and Behavioral and Psychological Symptoms of Dementia (BPSD). These symptoms are unpredictable and can lead to crises. In this context, cognitive-behavioral units (CBUs) have been created. Their aim is to stabilize behavioural disorders through rehabilitation programs. Objective The objective of this survey was to better understand the functioning of CBUs in the Rhône-Alpes region one year after their implementation. Method A questionnaire was administered to CBUs teams. The questionnaire included five items: patients, structure, CBUs teams, therapy, admission and orientation. Results Among the 8 CBUs contacted, 7 agreed to receive us. The responses show that the primary objectives are met as the structures accommodate patients presenting Alzheimer&#39;s disease and related disorders with BPSD and reduced behavioural problems through the institution of appropriate care. The average active file of CBUs was 91 patients, mean age 81.9 years, for a number of beds between 10 and 14. Sixty-seven percent of patients were coming from home with, in 66 % of cases, Alzheimer&#39;s disease (Mini-Mental Status average 12.3). The average length of stay was 36.4 days. The average Neuro-Psychiatric Inventory (NPI) on entry was 38.62 against 21.12 at the outlet. Conclusion Despite the differences observed between the CBUs, the survey shows common reflections and problems among them. It shows the interest for the CBUs to belong to a continuum of care.
Introduction La maladie d’Alzheimer est une maladie complexe avec un retentissement physique et p... more Introduction La maladie d’Alzheimer est une maladie complexe avec un retentissement physique et psychique sur le patient et son entourage. Ainsi, la prise en charge necessite l’intervention d’une equipe pluridisciplinaire pour proposer le projet de soin le plus adapte. Methodologie Au sein du CHU de Saint-etienne, nous avons cree une filiere de soins Alzheimer integrant plusieurs maillons : - consultations memoire - hopital de jour (depuis 1986) - service d’hospitalisation complete de neuro-psychogeriatrie, (depuis 2003). Les demandes emanant du pavillon d’urgence augmentent (patients hospitalises sous contrainte, patients errants dans les rues, refus de consultation, refus de suivi…). Aussi avons-nous voulu completer ces propositions de soins par la creation d’une equipe mobile : l’Unite de Prise en charge Extrahospitaliere de la precarite Cognitive (UPEPC) ; composee d’un medecin geriatre, d’une psychologue et d’une secretaire (a mi-temps depuis janvier 2009.) qui se deplace au domicile des patients presentant des troubles cognitifs et psychocomportementaux. Les objectifs sont d’anticiper les situations de crise et de proposer une alternative en cas de rupture de soins. Resultats de 4 mois de fonctionnement 52 visites a domiciles ont permis de faire une evaluation cognitive et psychologique de 36 patients en refus total de soins ; 47% des signalements ont ete effectue par les medecins traitants, 42% les medecins du CHU. 42% de refus d’aides a domiciles ; 16% refus de consultations memoire ; 16% refus d’hospitalisation et 42% troubles psychocomportementaux. L’echelle de Zarit retrouve un chiffre moyen de 41. Le MMS moyen etait de 19 /30 ; 42% des patients avaient eu un diagnostic neurologique etabli ; L’equipe de l’UPEPC a pu permettre d’eviter l’hospitalisation en urgence de ces 36 patients : 75% d’entre eux ont pu etre integres dans la filiere de soins (42% d’hospitalisations programmees et 56% maintenus a domicile). Conclusions Le deni des troubles et la resistance du patient (diagnostic, suivi, acceptation d’aides, separation avec le domicile) bloquent toute possibilite d’alliance therapeutique et ne peuvent, dans certains cas, que se gerer a domicile, veritable enjeu du suivi.
Cognitive-behavioral units (CBUs) have been created in the context of the national Alzheimer plan... more Cognitive-behavioral units (CBUs) have been created in the context of the national Alzheimer plan 2008/2012 for the management of behavioral disorders of patients suffering from Alzheimer&amp;amp;#39;s disease or related diseases. The Alzheimer plan promotes the evaluation of these units through the observation of the evolution of behavioral and psychological symptoms of dementia (BPSD). The aim of this study was to assess the effects of the memory center of Lyon (hospices civils de Lyon) CBU on BPSD. The neuropsychiatric inventory (NPI) was rated by the patients&amp;amp;#39; caregiver (NPI-F) at admission to the CBU and 2 weeks after the discharge. The NPI was also rated by the nursing staff (NPI-NS) 3 days after admission in the CBU and at discharge. All patients admitted in the CBU between July and October 2001 were included in the study for a total of 28 patients. A significant reduction of NPI-F scores between admission (58.93 ± 24.8) and 2 weeks after the discharge (27.07 ± 19.70) (P&amp;amp;lt;0.0001) was observed. Improvement was specifically observed for delusions, agitation, depression, anxiety, disinhibition and aberrant motor activity symptoms. No significant changes were found on NPI-NS scores. This study discloses benefits of CBUs in terms of BPSD reduction in patients 2 weeks after CBU discharge. These units have the potential to achieve their principal objective of reducing behavioral problems.
Introduction Notre enquete a porte sur une cohorte de personnes âgees suivies depuis 2001 pour de... more Introduction Notre enquete a porte sur une cohorte de personnes âgees suivies depuis 2001 pour determiner si le maintien des capacites cognitives chez de jeunes retraites vivant a domicile pouvait predire un vieillissement reussi quelques annees plus tard. Methodes 988 questionnaires ont ete envoyes aux sujets de la cohorte PROOF. Le vieillissement reussi a ete defini selon la notion de bien-etre a travers un score global d’etat de sante percu (“Comment percevez-vous votre etat de sante?”) et un score global de satisfaction (“Etes-vous en general satisfait de votre vie actuelle ?), mesures par des Echelles Visuelles Analogiques (EVA) graduees de 0 a 10. Les capacites cognitives avaient ete evaluees 6 ans plus tot selon une approche objective (epreuve de rappel libre/rappel indice (RL/RI) a 16 items, test de Benton et test des similitudes de la WAIS-3) et une approche subjective (EVA pour evaluer la plainte mnesique, echelle d’anxiete de Goldberg et echelle de Mac Nair). Resultats 686 questionnaires ont pu etre analyses. La moyenne d’âge des sujets etait de 72.9 ans +/-1,2 et on retrouvait 59.2% de femmes. 99% des personnes vivaient a domicile ; 24.5% vivaient seules. Parmi ceux qui avaient travaille, le nombre moyen d’annees de retraite etait de 13.7 ans +/- 4.1. Les personnes âgees vivant seules avaient un plus mauvais score d’etat de sante percu (p=0.0254) et de satisfaction (p Conclusion Le maintien des capacites cognitives chez de jeunes retraites vivant a domicile est un facteur predictif de vieillissement reussi autopercu 6 ans plus tard.
EUROQUEST was designed to explore various neuropsychiatric symptoms caused by neurotoxic agents i... more EUROQUEST was designed to explore various neuropsychiatric symptoms caused by neurotoxic agents in occupational epidemiological studies. This paper was aimed at assessing (i) the internal consistency of the French version of EUROQUEST, (ii) its sensitivity to age, educational level and exposure, (iii) and its convergent validity by examining relationships between declared symptoms and results from psychometric tests on the same mental functions. Data from four cross-sectional studies were selected: 180 workers exposed to toluene, mixed solvents or anaesthetic gas, and 588 non-exposed ones. The internal consistency of the questionnaire was assessed by computing Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alphas. Sensitivity to age, educational level and exposure were assessed with multiple linear regression models. Relationships between EUROQUEST scores and correspondent neuropsychological tests were assessed with Pearson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s correlation coefficients. The relationships between EUROQUEST domain specific scores, age and educational level were evaluated for men and women from the Reference group. Most of the analyses were performed in men and women separately. The results of the Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alphas computed for each EUROQUEST domain, showed a reasonable internal consistency for the questionnaire. For both women and men, memory problems and sleep disorders increased significantly with age. A significant association between EUROQUEST scores and exposure to neurotoxic agents was found for workers exposed to anaesthetic gas only. In addition, EUROQUEST memory symptoms from the Reference population were found to be correlated with two memory neuropsychological tests, both for men and women. Our results showed a high internal consistency and a good convergent validity on assessed domains. Moreover, they showed a significant sensitivity to age, educational level and highlighted sensitivity to anaesthetic gas exposure.
This study examined the short-term relationships between the work conditions during the day prece... more This study examined the short-term relationships between the work conditions during the day preceding the data collection, including working hours, subsequent sleep and cognitive efficiency. The study also addressed the issue of whether this relationship differed as a function of age. The data were taken from the cross-sectional phase of the VISAT study (Aging, Health, and Work, Marquié et al., 2002). The sample included 3237 wage earners from both genders, aged from 32 years to 62 years old at the time of the first measurement, and working in a wide range of jobs. The data included detailed information on present and past working conditions, sleep and health. It also included an assessment of cognitive efficiency (immediate and delayed memory, speed, and attention). Preliminary results based on multiple regression analyses showed that working before 6 a.m. or after 10 p.m. on the previous day was significantly associated with poorer cognitive efficiency, even after adjustment for gender and educational level, and after statistical control of factors such as sleep duration, perceived sleep quality, and other work characteristics of the previous day. No interaction was found between age and working hours, thus indicating that the observed effects of an atypical work schedule during the previous day on cognitive performance was similar for all ages (additive effect).
Previous studies have assessed the relationship between subjective cognitive complaints and objec... more Previous studies have assessed the relationship between subjective cognitive complaints and objective impairment. While some of them found that cognitive complaints were explained by affective disorders, other researches found a relationship between cognitive complaints and neuropsychological performance. Most of them focused on memory functioning. However, elderly normal adults also display a decline in executive functions. This study aimed to assess the relationship between cognitive complaints, objective memory and executive performance and affective disorders. This study was carried out with 937 community-dwelling elderly individuals recruited from the electoral list of the city of Saint-Etienne, France. Cognitive complaints were assessed using the MacNair scale. Cognitive performances were measured via a large battery of memory and executive-performance tests chosen for their capacity to detect subtle cognitive impairment. Anxiety and depressive symptoms were assessed using scales devised by Pichot and Goldberg. Cognitive complaints were associated with lower scores on verbal-memory tests and several executive-performance tests. Moreover, affective disorders were related to some of the executive-performance test scores, but they were not related to scores on the Free and Cued Selective Reminding Test, Digit Symbol Substitution Test and Trail Making B scores. Cognitive complaints of the elderly can reflect objective memory and executive-performance impairments, independent of affective disorders. Cognitive complaints should be assessed using both memory and executive-performance tests.
Elderly subjects diagnosed with mild cognitive impairment (MCI) are becoming the target of interv... more Elderly subjects diagnosed with mild cognitive impairment (MCI) are becoming the target of intervention trials. The criteria used for MCI are principally issued from prospective clinical studies, although longitudinal population-based studies having identified several cognitive predictors of dementia can be of great contribution in the definition of these criteria. This study was conducted to explore the external validity of MCI criteria issued from a longitudinal population-based study, and subsequently to identify the best predictors of the short-term conversion to Alzheimer’s disease 2 years after the MCI diagnosis. Ninety elderly volunteers with memory complaint diagnosed with MCI on the basis of their functional and neuropsychological performances were followed up within 2 years. The potential predictors of the conversion to dementia collected at baseline included age, gender, educational level, size of temporal lobe, apolipoprotein E genotype and a series of neuropsychological...
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Papers by Isabelle Rouch