Psychologie & Neuropsychiatrie Du Vieillissement最新文献

{"title":"[Decision making in the elderly: which tools for its evaluation by the clinician?].","authors":"Caroline Hommet,&nbsp;Thierry Constans,&nbsp;Boriana Atanasova,&nbsp;Karl Mondon","doi":"10.1684/pnv.2010.0221","DOIUrl":"https://doi.org/10.1684/pnv.2010.0221","url":null,"abstract":"<p><p>Numerous decision-making situations occur in the activities of daily living. The consequences of the decision-making capacity disturbances may have a great impact on the patient's autonomy, financial management, and his or her reaction to a diagnosis as well as the ability to accept a therapeutic option or give informed consent. Decision-making is a complex and multi-dimensional process and brings into play attention, memory and executive functions, which are processed in the prefrontal cortex, particularly vulnerable in aging. A better comprehension of the mechanisms of decision-making, and of the resulting social consequences of their dysfunction may improve autonomy of the elderly. Unfortunately, we still lack appropriate tools to explore decision-making in routine practice.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 3","pages":"201-7"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/pnv.2010.0221","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29211271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[DEX and executive dysfunction in activities of daily living in Alzheimer's disease and frontotemporal dementia].","authors":"Ambre Piquard,&nbsp;Christian Derouesné,&nbsp;Vincent Meininger,&nbsp;Lucette Lacomblez","doi":"10.1684/pnv.2010.0220","DOIUrl":"https://doi.org/10.1684/pnv.2010.0220","url":null,"abstract":"<p><strong>Unlabelled: </strong>The questionnaire DEX was designed by Wilson et al. in 1996 to explore the disturbances of executive functions (EF) in activities of daily living (ADL).</p><p><strong>Objective: </strong>This study was performed to explore the specificity of the DEX to evaluate executive dysfunction in ADL, and its contribution to the distinction between Alzheimer's disease (AD) and frontotemporal dementia (FTD).</p><p><strong>Subjects: </strong>13 patients with the frontal variant of FTD, 19 patients with FTD associated with amyotrophic lateral sclerosis, FTD/SLA, 18 patients with Alzheimer's disease, AD, and 24 controlled subjects.</p><p><strong>Methods: </strong>The scores on the DEX completed by a proxy as well as those on two scales assessing ADL (the Cognitive Difficulties Scale by McNair & Kahn, and a composite scale (NADL) including the evaluation of basic (BADL) and instrumental (IADL) by the Lawton & Brody scales, and of social activities (SADL) from Katz & Lyerly) were compared to neuropsychological tests assessing EF (Behavioural Assessment of Dysexecutive Syndrome (BADS), Wisconsin Card Sorting Test, Stroop test, Trail Making Test B, lexical and categorical verbal fluencies, WAIS-III similarities).</p><p><strong>Results: </strong>No correlation was found between the scores on the DEX or the other ADL scales, and the BADS scores. Scores on DEX showed some weak correlations with some executive tasks, but no stronger than those found with the other ADL scales. Analysis of the most frequently perturbed DEX items failed to show a characteristic profile for EF dysfunction. No significant difference was found between patients with AD and DFT on the scores on the DEX as well as on other ADL scales, when adjusted for dementia severity (assessed by the Mattis Dementia Rating Scale (MDRS)). No difference was found between MA and DFT patients neither in the profile of the most frequently perturbed DEX items, nor in decreased awareness of the disorders assessed by comparison of the scores on the DEX completed by patients and familiars.</p><p><strong>Conclusion: </strong>In this study, DEX does not appear as a specific tool for assessing EF dysfunction in ADL compared to other ADL scales. It was more related to global cognitive difficulties as assessed by the CDS and the MDRS. Scores on the DEX as well as on other ADL scales do not contribute to the distinction between AD and FTD.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 3","pages":"215-24; quiz 225-7"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/pnv.2010.0220","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29211273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Multiple system atrophy].","authors":"Nathalie Damon-Perrière,&nbsp;François Tison,&nbsp;Wassilios G Meissner","doi":"10.1684/pnv.2010.0212","DOIUrl":"https://doi.org/10.1684/pnv.2010.0212","url":null,"abstract":"<p><p>Multiple system atrophy (MSA) is a sporadic neurodegenerative disorder of unknown etiology. It is the most frequent disorder among atypical parkinsonism with an estimated prevalence of 2 to 5 per 100 000 inhabitants. The clinical symptoms are rapidly progressing with a mean survival ranging between 6 to 9 years. The diagnosis is based on consensus criteria that have been revised in 2008. The diagnostic criteria allow defining \"possible\", \"probable\" and \"definite\" MSA. The latter requires post mortem confirmation of striatonigral and olivopontocerebellar degeneration with alpha-synuclein containing glial cytoplasmic inclusions. The diagnosis of \"possible\" and \"probable\" MSA is based on the variable presence and severity of parkinsonism, cerebellar dysfunction, autonomic failure and pyramidal signs. According to the revised criteria, atrophy of putamen, pons, middle cerebellar peduncle (MCP) or cerebellum on brain magnetic resonance imaging are considered to be additional features for the diagnosis of \"possible\" MSA. T2-weighted brain imaging may further reveal a putaminal hypointensity, a hyperintense lateral putaminal rim, the so called \"hot cross bun sign\" and MCP hyperintensities. Cardiovascular examination, urodynamic testing and anal sphincter electromyography may be helpful for the diagnosis of autonomic failure. Some patients may respond to levodopa, but usually to a lesser extent than those suffering from Parkinson's disease, and high doses are already required in early disease stages. No specific therapy is available for cerebellar dysfunction, while effective treatments exist for urinary and cardiovascular autonomic failure. Physical therapy may help to improve the difficulties of gait and stance, and to prevent their complications. In later disease stages, speech therapy becomes necessary for the treatment of dysarthria and dysphagia. Percutaneous gastrostomy is sometimes necessary in patients with severe dysphagia. Beyond these strategies, psychological support, social care and occupational therapy to adapt the environment to the patient's disability are prerequisites for improving the quality of life in MSA patients.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 3","pages":"179-91"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/pnv.2010.0212","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29211269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Obstructive sleep apnea and cognitive impairment in the elderly].","authors":"Fannie Onen,&nbsp;Hakki Onen","doi":"10.1684/pnv.2010.0219","DOIUrl":"https://doi.org/10.1684/pnv.2010.0219","url":null,"abstract":"<p><p>Obstructive Sleep Apnea Syndrome (OSAS) is characterized by repeated episodes of upper airway obstruction during sleep that result in intermittent hypoxemia and arousal. The prevalence of OSAS increases with aging, occurring in up to 25% of older adults and up to 48% in patients with Alzheimer's disease. OSAS causes hypoxia, fragmented sleep, daytime sleepiness, cognitive dysfunction, functional decline, and brain damage resulting from reduced cerebral blood flow, ischemic brain lesions, microvascular reactivity, white matter lesions, and grey matter loss. OSAS is considered as an independent risk factor for hypertension, stroke and mortality. The treatment of choice for OSAS is continuous positive airway pressure (CPAP). OSAS-related cognitive dysfunction has been shown in a variety of domains including attention, executive functioning, motor efficiency, working memory, and long-term episodic memory. Proposed mechanisms include hypoxemia, sleep fragmentation and inflammatory process, but it remains unclear which mechanisms underlie the relationship between OSAS and disturbances in the different cognitive domains. Recent studies suggest that OSAS may exacerbate cognitive functioning in dementia and that CPAP therapy can be applied to these patients and improve cognitive functioning.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 3","pages":"163-9"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/pnv.2010.0219","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29211826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Atrial fibrillation and cognitive function].","authors":"Emmanuelle Duron,&nbsp;Olivier Hanon","doi":"10.1684/pnv.2010.0222","DOIUrl":"https://doi.org/10.1684/pnv.2010.0222","url":null,"abstract":"<p><p>Atrial fibrillation (AF), which prevalence increases with age, is a growing public health problem and a well known risk factor for stroke. On the other hand, dementia is one of the most important neurological disorders in the elderly, and with aging of the population in developed countries, the number of demented patients will increase in absence of prevention. In the past decade, several vascular risk factors (hypertension, obesity and metabolic syndrome, hypercholesterolemia) have been found, with various degree of evidence, to be associated with vascular dementia but also, surprisingly, with Alzheimer's disease. This review is devoted to the links between atrial fibrillation, cognitive decline and dementia. Globally, transversal studies showed a significant association between atrial fibrillation, cognitive decline and dementia. However, these studies are particularly sensitive to various biases. In this context, recent longitudinal studies of higher level of evidence have been conducted to assess the link between AF and dementia. One study disclosed a high incidence of dementia among patients suffering from atrial fibrillation during a 4.6 years follow-up. Similarly another study showed that atrial fibrillation was significantly associated with conversion from mild cognitive impairment to dementia during a 3 years follow-up. Nevertheless two other longitudinal studies did not find any significant association between AF and dementia, but this discrepancy should be interpreted taking into account that the comparability of all these studies is moderate because they were using different methodologies (population, cognitive testing, and mean follow-up). Possible explanatory mechanisms for the association between AF and the risk of dementia are proposed, such as thrombo-embolic ischemic damage and cerebral hypo perfusion due to fluctuations in the cardiac output. Thus, there is some evidence that FA could be associated with cognitive decline and dementia but this link should be supported by more powerful long term longitudinal studies.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 3","pages":"209-14"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/pnv.2010.0222","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29211272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Sleep and depression in elderly people].","authors":"Alain Nicolas,&nbsp;Jean-Michel Dorey,&nbsp;Eric Charles,&nbsp;Jean-Pierre Clement","doi":"10.1684/pnv.2010.0224","DOIUrl":"https://doi.org/10.1684/pnv.2010.0224","url":null,"abstract":"<p><p>Mood disorders and sleep disturbances are closely related. In elderly people, the prevalence of insomnia and depressive symptoms is increased. Moreover, somatic co-morbidities associated with aging are known to be risk factors for both insomnia and depression. Assessment of the origin of sleep complaints must consider primary and secondary insomnia, and the existence of associated depression. Causal treatment of insomnia is necessary keeping in consideration that depressive dimension can, afterward, evolve on its own. In presence of intense sleep complaints in inadequacy with somatic examination, and not documented by sleep recordings, depression must be evoked. In patients with a diagnosis of depression, treatment and monitoring of the evolution of insomnia is necessary, because persistent disturbances of sleep are associated with poor prognosis. Concerning the therapeutics, beyond antidepressant treatment and psychotherapy, chronotherapy is a promising, but still not yet evaluated, approach, which presents the advantage to limit the use of psychotropics drugs.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 3","pages":"171-8"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/pnv.2010.0224","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29211268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Which brakes upon severe dementia clinical research?].","authors":"Anne-Sophie Gillioz,&nbsp;Hélène Villars,&nbsp;Pierre-Yves Malo,&nbsp;Gaëlle Silvestre,&nbsp;Pierre Jouanny","doi":"10.1684/pnv.2010.0213","DOIUrl":"https://doi.org/10.1684/pnv.2010.0213","url":null,"abstract":"<p><p>Publications devoted to severe dementia remain limited, whereas several authors underline the need to carry on clinical research in the field. The aim of this paper is to analyze the various technical, psychological and sociological factors that slow down the development of clinical research in severe dementia. To reduce these obstacles seems of main interest considering the economic, medical and human issues related to the severe stage of dementia.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 3","pages":"193-9"},"PeriodicalIF":0.0,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/pnv.2010.0213","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29211270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Editorial].","authors":"Christian Derouesné","doi":"10.1684/pnv.2010.0216","DOIUrl":"https://doi.org/10.1684/pnv.2010.0216","url":null,"abstract":"","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 2","pages":"85"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29034036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Vocally disruptive behaviors].","authors":"Dominique Manière,&nbsp;Marc Morlet,&nbsp;Louis Ploton","doi":"10.1684/pnv.2010.0211","DOIUrl":"https://doi.org/10.1684/pnv.2010.0211","url":null,"abstract":"<p><p>Vocally disruptive behaviors are not uncommon in the elderly, especially in dementia and institutionalization context. Although they do not constitute the most frequent of the behavioral symptoms of dementia, they are one of the most disturbing and therefore a challenge for nursing home staff. They can result in serious consequences for the patient itself as well as for caregivers, nursing staff and other residents. An increasing number of studies have been performed on the vocally disruptive behaviors during the last years, but most of studies were devoted to individual cases or very small series. Nevertheless, a review of the literature may provide some suggestions for their management.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 2","pages":"111-21"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29035616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Diogenes's syndrome: an observatory study in a Paris district].","authors":"Jean-Claude Monfort,&nbsp;Laurence Hugonot-Diener,&nbsp;Emmanuel Devouche,&nbsp;Catherine Wong,&nbsp;Isabelle Péan","doi":"10.1684/pnv.2010.0215","DOIUrl":"https://doi.org/10.1684/pnv.2010.0215","url":null,"abstract":"<p><strong>Introduction: </strong>Diogenes syndrome, DS, is a behavioral disorder affecting more often older adults. It is a controversial syndrome with at least 4 almost permanent symptoms: no request from the subject although he possesses nothing; unusual relationship with objects (hoarding of rubbish, or nothing in the house); unusual relationship with people (misanthropy) and extreme self-neglect. Difficulties in taking care of such subjects has conducted the socio-medical team to carry out a descriptive study to find out if these subjects had a pathological state or not.</p><p><strong>Method: </strong>A retrospective observatory survey based on 600 questionnaires sent to medical and social workers to describe potential cases of DS.</p><p><strong>Results: </strong>136 questionnaires concerning 121 subjects have been completed by 53 professional workers, which represent 1.6 case for 10,000 individuals. Mean age of the subjects was 77.8 +/- 9.9 years (range 52 to 95); 71% were women. All socio professional categories were represented among the patients. Half of the patients had a psychiatric disorder and 26% a dementia; 7% were alcohol addicts. One forth of DS had no associated mental pathology, and could be primary, but a \"queer\" personality was reported in these cases and a traumatism during childhood in 12%.</p><p><strong>Conclusion: </strong>The variety of the clinical typology may explain the controversial data on the literature about the relevance of this syndrome. We propose 14 different types according to the present symptoms, and eventual associated mental pathology. In primary SD, without associated psychiatric pathology, an \"exceptional\" personality and, in 12% of cases, a traumatism during childhood were reported. These results may help designing a future prospective study.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 2","pages":"141-53"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29035619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}