Psychologie & Neuropsychiatrie Du Vieillissement最新文献

{"title":"[Acetylcholinesterase inhibitors in Alzheimer's disease: further comments on their mechanisms of action and therapeutic consequences].","authors":"André Nieoullon","doi":"10.1684/pnv.2010.0208","DOIUrl":"https://doi.org/10.1684/pnv.2010.0208","url":null,"abstract":"<p><p>Cholinergic treatments in Alzheimer's disease are related to the decline of cholinergic central transmission evidenced many years ago in patients. Donepezil, rivastigmine and galantamine have been shown to improve the biodisponibility of acetylcholine at synaptic level by decreasing its enzymatic degradation through acetylcholinesterases. Indeed these cholinesterase inhibitors have shown clinical beneficial effects especially at the early stages of the disease and when the cognitive deterioration is still limited. However, depending on patients, their efficacy can be discussed since the amplitude of the improvement has been recognized as limited. Nevertheless, cholinesterase inhibitors can improve the cognitive capacities or attentional processes in patients and their capability to be autonomous in daily life activities. Differences reported between the three different major cholinesterase inhibitors could be due to different pharmacokinetic and pharmacodynamic properties, especially with regard to the duration and reversibility of acetylcholinesterase inhibition. Since the resulting effect of the different compounds is to increase the synaptic acetylcholine disponibility in all cases, it is generally accepted that therapeutic effects are related to cholinergic stimulation in the brain structures involved in the regulation of cognitive and behavioral processes, with special reference to alpha7 nicotinic receptor subtype, which are concentrated in the cerebral cortex and hippocampal formation. Because of the involvement of such nicotinic receptor subtype in presynaptic activation of numerous neurotransmitters synaptic functions, one can propose that such general stimulation of brain structures contributes to behavioral improvement. Interestingly, data from experimental literature also showed that acetylcholinesterase inhibitors may have neuroprotective effects and could thus act as disease modifiers in patients, slowing the progression of behavioral deterioration since acetylcholinesterases themselves could contribute to the degenerative process. However such a speculative proposal has to be demonstrated in patients.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 2","pages":"123-31"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29035617","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":"[Disruptive nocturnal behavior in elderly subjects: could it be a parasomnia?].","authors":"Smaranda Leu-Semenescu,&nbsp;Isabelle Arnulf","doi":"10.1684/pnv.2010.0210","DOIUrl":"https://doi.org/10.1684/pnv.2010.0210","url":null,"abstract":"<p><p>Parasomnias are sleep-related abnormal behaviors. They are frequent and overlooked causes of nocturnal disruptive behavior in the elderly, especially when patients are cognitively impaired. Confusion and violence can result in sleep disruption, injuries for the patients or their bed partners, caregivers distress, and they can be a motive for institutionalization. Parasomnias include the NonREM sleep disorders of arousal (sleepwalking, sleep terrors, confusional arousals and sleep-related eating disorder), the REM sleep behavior disorder (RBD) and more rarely the parasomnia overlap syndrome, which associates both NREM and REM parasomnias. Patients with NREM sleep parasomnias are confused, eyes open, with a glazed look during their nocturnal behaviors, and they have a post-episode amnesia. They shout and bolt from the bed (night terrors), look about in a confused manner, walk and speak (sleepwalking), and eat peculiar or inedible food (sleep-related eating disorders). These behaviors, which are frequent in young adults, may be triggered by short-half live hypnotics in elderly. During the parasomnia, the brain is partially awake (enough to perform complex motor and verbal action), and partially asleep (without conscious awareness or responsibility). RBD is characterized by a loss of the normal muscle atonia that accompanies REM sleep. Patients have excessive motor activity such as punching, kicking, or crying out in association with dream content. RBD are frequent in Parkinson's disease and dementia with Lewy bodies and may precede the cognitive or motor symptoms of these diseases by 5 to 10 years. RBD can also be promoted by antidepressants. When combined with thorough clinical interviews, the video-polysomnography is a powerful tool, especially for discriminating the parasomnia from nocturnal frontal lobe epilepsy, sleep apneas and periodic leg movements. Ensuring safety and withdrawing deleterious treatments are useful in patients with violent activities, potential injurious or bothersome to other household members. Clonazepam and melatonin (3-12 mg) are highly effective for treating RBD.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 2","pages":"97-109"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29034038","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":"[Cognitive reserve and neuronal changes associated with aging].","authors":"Sylvia Villeneuve,&nbsp;Sylvie Belleville","doi":"10.1684/pnv.2010.0214","DOIUrl":"https://doi.org/10.1684/pnv.2010.0214","url":null,"abstract":"<p><p>The severity of brain lesions is not a perfect predictor of the severity of cognitive deficits in age-related brain disorders, an observation which has led to the cognitive reserve hypothesis. According to this hypothesis, cognitive reserve modulates the relationship between cerebral lesions and their clinical manifestations by limiting the negative impact of cerebral lesions on cognition. Thus, individuals with high cognitive reserve could sustain a greater amount of neuropathological lesions before they reach the criteria for dementia. The goal of this review is to present and discuss the notion of cognitive reserve, a hypothesis that brings a novel perspective to the complexity of normal and pathological cognitive aging. The present article describes the neuronal mechanisms proposed to underlie cognitive reserve and the factors that increase and decrease reserve. In addition, influent studies that have measured the cognitive reserve hypothesis in clinical populations are presented.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 2","pages":"133-40"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29035618","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":"[Dreams in normal and pathological aging].","authors":"Fabian Guénolé,&nbsp;Geoffrey Marcaggi,&nbsp;Jean-Marc Baleyte,&nbsp;Lucile Garma","doi":"10.1684/pnv.2010.0209","DOIUrl":"https://doi.org/10.1684/pnv.2010.0209","url":null,"abstract":"<p><p>Although most of scientific knowledge in dream research is based on young adult studies, this article provides a review of the effects of normal and pathological aging on dream psychology. It starts with preliminary comments about epistemological and methodological principles of dream research, its singularities in aged persons, and the modifications of sleep physiology with age. The whole literature agrees that dream recall progressively decreases from the beginning of adulthood - not in old age - and that dream reports become less intense, perceptually and emotionally. This evolution occurs faster in men than women, with gender differences in the content of dreams. The chronological modifications could be explained partly by changes in lifestyle and attitude towards dreams in early adulthood, but mainly by modifications of sleep physiology, particularly the decrease and qualitative changes of rapid eye movement (REM) sleep. Dreams have usually little subjective importance in the mental life of aged persons. However, working with dreams can be a valuable tool for psychotherapy in the aged. According to the few existing data, patients suffering degenerative dementia dream much less than healthy aged persons. In Alzheimer's disease, this could be linked to the decrease of REM sleep, and atrophy of associative sensory areas of the cerebral cortex. Most studied aspects of dreaming in degenerative cognitive disorders are REM sleep behavior disorders, and nightmares induced by cholinesterase inhibitors. More studies are needed to better characterize the evolution of dreams with age, particularly studies performed in sleep laboratory.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 2","pages":"87-96"},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/pnv.2010.0209","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29034037","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":"[Voting by cognitively impaired persons: legal and ethical issues].","authors":"Antoine Bosquet,&nbsp;Amar Medjkane,&nbsp;Philippe Vinceneux,&nbsp;Isabelle Mahé","doi":"10.1684/pnv.2009.0181","DOIUrl":"https://doi.org/10.1684/pnv.2009.0181","url":null,"abstract":"<p><p>In democratic countries, cognitively impaired persons are a substantial and growing group of citizens. Most of them are citizens with dementia. In dementia, cognitive impairment induces a loss of some capacities, resulting in vulnerability and increased need for assistance. Voting by cognitively impaired persons raises any questions about the integrity of the electoral process, the risk of fraud and the respect of their citizenship. In France, the law is not definite about the voting of cognitively impaired persons. An objective assessment for voting capacity may be useful both for professionals in charge of voting organisation and for guardianship judge in order to help him in his decision to remove or keep the voting right of persons placed under guardianship. Assessing the reality of voting by cognitively impaired citizens is necessary to advance respect for their right to vote.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 1","pages":"33-42"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/pnv.2009.0181","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28765553","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":"[Contribution of various MRI techniques to the characterization of Mild cognitive impairment].","authors":"Caroline Baclet-Roussel,&nbsp;Joël Ankri,&nbsp;Anne-Marie Ergis","doi":"10.1684/pnv.2010.0200","DOIUrl":"https://doi.org/10.1684/pnv.2010.0200","url":null,"abstract":"<p><p>Mild cognitive impairment (MCI) is considered as a strong risk factor for Alzheimer's disease (AD) or other dementia syndromes. Since the last decade, numerous publications have been aimed to characterize early detectable brain changes in vivo, using more and more efficient neuroimaging techniques. This review is devoted to the brain damages detectable in MCI patients according to the MRI techniques available to date. The greatest number of studies, using structural and functional imaging, report many abnormalities principally located in the medial temporal lobe. They show, especially in this region, cortical atrophy, reduction of glucose metabolism, decrease in regional cerebral blood flew and biochemical changes. Moreover, progresses in the functional methods allow to detect brain activity during memory tasks, trying to specify whether this activity increases or decreases according to the task and the severity of cognitive impairment. The contribution of each RMI technique (morphologic, metabolic, and functional) is addressed in order to reveal how relevant they are to distinguish subjects with MCI from patients with early AD. Furthermore, their relevance to discriminate between MCI with different degrees of cognitive deficit and their power to predict the risk of conversion to AD is discussed. Finally, we review the main assumptions made to explain the underlying mechanisms of cognitive decline and present evidences in favor of dynamic compensatory processes, existence of cognitive reserve and disconnection processes. Many neuroimaging data support the pattern of installation and evolution of brain damages found in AD, reinforcing the idea that a part of amnesic MCI is probably a prodromal state of AD.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 1","pages":"53-64"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/pnv.2010.0200","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28763620","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":"[Contribution of pictorial help to the understanding of medical prescriptions in elderly adults and in patients with Alzheimer's disease].","authors":"Emmanuel Monfort,&nbsp;Philippe Allain,&nbsp;Frédérique Etcharry-Bouyx,&nbsp;Didier Le Gall","doi":"10.1684/pnv.2010.0201","DOIUrl":"https://doi.org/10.1684/pnv.2010.0201","url":null,"abstract":"<p><p>The effects on comprehension of presenting medical prescription information in a pictorial format were compared to a verbal format in healthy old adults and in patients suffering from Alzheimer disease (AD). Participants received medical prescription instructions in one of two formats: with verbal instructions only, or with verbal instructions associated with pictorial representations. The results indicated that comprehension for prescription information of healthy old subjects and AD patients was facilitated by the combined presentation. Furthermore, the pictorial instructions appeared acting on the capacity to work out a specific medication schemata, that is to say on their real, operational, understanding. These results suggest that analogical pictorial format leads more directly to the medical prescriptions' situation model and alleviates the particularization deficiency of the therapeutic schemata, independently of global cognitive functioning, visual perception, space perception and visual semantic analysis in AD. The presentation of illustrations representing medical prescriptions would allow to decrease doubts and errors, which are frequent in normal aging and even more in Alzheimer's disease, and contribute to a better medical compliency.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 1","pages":"65-75"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28763621","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 changes with aging].","authors":"Christophe Arbus,&nbsp;Valérie Cochen","doi":"10.1684/pnv.2010.0205","DOIUrl":"https://doi.org/10.1684/pnv.2010.0205","url":null,"abstract":"<p><p>Many factors contribute to the alteration of sleep in older adults. Most of their complaints can be explained by the modifications of the sleep organisation observed in this population. Sleep architecture is altered with aging. Insomnia and excessive daytime sleepiness can reflect an alteration of the circadian rhythm. This population is also frequently exposed to specific sleep disorders such as the restless leg syndrome, periodic limb movements or obstructive sleep apnea syndrome. Sleep disorders in patients with Alzheimer's disease is a daily preoccupation at home or in institution. Circadian rhythm modifications and sleep disorders are frequent in this frail population and can induce disturbing behavior disorders. Before the prescription of hypnotics and psychotropic drugs, facing a sleep complaint practitioners should take into account the risks induced by these treatments that should no longer be the unique and reflex treatment in these situations.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 1","pages":"7-14"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/pnv.2010.0205","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28765548","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 disturbances in Alzheimer's disease and other dementias].","authors":"Marie-Françoise Vecchierini","doi":"10.1684/pnv.2010.0203","DOIUrl":"https://doi.org/10.1684/pnv.2010.0203","url":null,"abstract":"<p><p>Sleep in dementias has been mainly studied in Alzheimer disease (AD). Sleep disturbances are found in 25 to 35% of subjects with AD. Subjective and objective disturbances are described. Long nocturnal awakenings disrupt sleep; total sleep time and sleep efficiency are reduced. Slow wave sleep is decreased and sometimes disappears. REM sleep percentage is also reduced and at a later stage of the disease, REM latency is increased. Sleep fragmentation can be associated with excessive daytime napping and sleepiness, and with other behavioral symptoms such as the sundowning syndrome and nocturnal agitation. Sleep abnormalities closely parallel the level of severity of dementia. The rest/activity ratio and the sleep-wake rhythms are more and more disturbed; the phase delay of the temperature rhythm is associated with the severity of the sundowning syndrome. Sleep disturbances and behavioral symptoms are the main reasons to institutionalize the patient. Sleep disturbances are related to multiple factors. Pathophysiological changes resulting of the disease itself, such as damage to the cholinergic pathways and to the circadian pacemaker in the suprachiasmatic nucleus, contribute to sleep changes in AD. Associated medical and psychiatric illness and their different treatments as well as environmental factors also induced sleep disturbances. Sleep-disordered breathing is a highly prevalent condition in AD patients and restless leg syndrome may account for nocturnal agitation. In Parkinson and in Lewy body dementias, sleep disturbances are more severe than in DA and REM sleep behavior disorder can precede by several years these diseases. Sleep attacks and sleepiness are very frequent in Parkinson disease. Specific etiologies should drive specific treatment. Several non pharmacologic treatments are usually associated to treat sleep disturbances in AD: information, increased daytime physical, social activities to minimize daytime naps and exposure to bright light. Some studies found advantages to associate melatonin in the evening.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 1","pages":"15-23"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/pnv.2010.0203","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28765549","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":"[Aphasia in elderly patients].","authors":"Olivier Moreaud,&nbsp;Danielle David,&nbsp;Marie-Pierre Brutti-Mairesse,&nbsp;Matthieu Debray,&nbsp;Armelle Mémin","doi":"10.1684/pnv.2009.0185","DOIUrl":"https://doi.org/10.1684/pnv.2009.0185","url":null,"abstract":"<p><p>Aphasia is common in elderly patients in the context of vascular or neurodegenerative disorders. In some cases, aphasia is an isolated symptom, occurring suddenly after a stroke, or developing progressively as a primary progressive aphasia. The diagnosis and treatment are then very similar in older and younger patients. Therapy may be more complicated because of the high prevalence, in older patients, of associated non linguistic symptoms (attentional and dysexecutive symptoms, behavioral and psychological symptoms or sensorial deficits), fatigability, and comprehension deficits. It may then become very difficult to recognize aphasia among all these disorders and to appreciate the physiopathology. A complete evaluation of language, cognitive functions, psychopathology, and behavior is very helpful, as are neuroimaging techniques (MRI is the most relevant). A good knowledge of classical aphasic pictures associated with stroke, Alzheimer disease or related disorders, is highly recommended. Rehabilitation must be proposed even for older patients, so far as aphasia alters the communication abilities. It must be kept in mind that associated symptoms may limit considerably the therapy.</p>","PeriodicalId":54537,"journal":{"name":"Psychologie & Neuropsychiatrie Du Vieillissement","volume":"8 1","pages":"43-51"},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1684/pnv.2009.0185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28765554","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}