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A Alperovitch

Publications and source records attributed to A Alperovitch.

At least 19 recordsLinked to original sources
PubMed2005

Mortality from Creutzfeldt-Jakob disease and related disorders in Europe, Australia, and Canada.

BACKGROUND: An international study of the epidemiologic characteristics of Creutzfeldt-Jakob disease (CJD) was established in 1993 and included national registries in France, Germany, Italy, the Netherlands, Slovakia, and the United Kingdom. In 1997, the study was extended to Australia, Austria, Canada, Spain, and Switzerland. METHODS: Data were pooled from all participating countries for the years 1993 to 2002 and included deaths from definite or probable CJD of all etiologic subtypes. RESULTS: Four thousand four hundred forty-one cases were available for analysis and included 3,720 cases of sporadic CJD, 455 genetic cases, 138 iatrogenic cases, and 128 variant cases. The overall annual mortality rate between 1999 and 2002 was 1.67 per million for all cases and 1.39 per million for sporadic CJD. Mortality rates were similar in all countries. There was heterogeneity in the distribution of cases by etiologic subtype with an excess of genetic cases in Italy and Slovakia, of iatrogenic cases in France and the UK, and of variant CJD in the UK. CONCLUSIONS: This study has established overall epidemiologic characteristics for Creutzfeldt-Jakob disease (CJD) of all types in a multinational population-based study. Intercountry comparisons did not suggest any relative change in the characteristics of sporadic CJD in the United Kingdom, and the evidence in this study does not suggest the occurrence of a novel form of human bovine spongiform encephalopathy infection other than variant CJD. However, this remains a possibility, and countries currently unaffected by variant CJD may yet have cases.

Adolescent↗
PubMed2005

[Prevalence of asymptomatic atherothrombotic lesions and risk of vascular events in patients with documented coronary artery disease].

Coronary arteries are the most frequent location of atherosclerosis. Coronary artery disease is the first cause of death related to atherothrombosis. In addition, patients with a prior history of acute coronary syndromes exhibit a 10% annual risk of recurrence. Although there seems to be a close correlation between the extension of CAD and the severity of atherosclerotic lesions in extra coronary arterial beds, the prevalence of these extracoronary asymptomatic lesions depends on their location. Hence, the prevalence of renal artery disease defined as stenosis > or = 50% or of peripheral artery disease defined as an ABI < 0.9 is estimated to be 20% up to 30%, whereas the prevalence of both carotid artery disease defined as stenosis > or = 70% or aortic aneurysm is estimated to be 5%. Conversely, the annual absolute risk of stroke among CAD patients is estimated at 1% while it remains unknown for vascular events related to PAD or aortic lesions. These data suggest that a systematic screening for asymptomatic extracoronary atherosclerotic lesions among CAD patients cannot be justified without a better knowledge of the prevalence of these lesions. In addition, the identification of the predicting factors for the presence and the development of these asymptomatic lesions is warranted. Finally, the potential benefit in terms of therapeutic intervention of such screening needs to be evaluated. These important issues warrant further clinical studies with appropriate design.

Coronary Artery Disease↗
PubMed2005

[Epidemiology of athrotherombotic lower limb arterial disease].

Chronic occlusive arterial disease of the lower limbs is a common presentation of atherothrombotic disease. This systematic review of the literature analyses the natural history of this condition and the prevalence of asymptomatic lesions of other arterial localisations requiring specific treatment. The Medline database was researched and completed by a bibliography of the principal articles selected, Internet sites and their publication reviews and also the Cochrane database. The incidence of systemic complications has been assessed in many good quality epidemiological study. It increases with the severity of lower limb arterial disease, but in asymptomatic patients defined by a pathological systolic pressure index (< 0.90) the cardiovascular mortality is already 2% per year, the incidence of myocardial infarction 3% per year and that of cerebrovascular accidents 1 to 2% per year. The prevalence of asymptomatic lesions in other arterial sites is less well documented, the evaluations varying according to the population studied and criteria of significant lesions: 21 to 69% for coronary artery disease, 12 to 59% for carotid artery stenosis, 14 to 40% for renal artery stenosis and 6 to 14% for abdominal aortic aneurysms. Despite the uncertainty of these estimations, the prevalence of asymptomatic atherothrombotic lesions is high in all arterial networks and justifies the setting up of studies to assess the clinical benefits of their systematic diagnostic investigations.

Arteriosclerosis↗
PubMed2004

Predictors of survival in sporadic Creutzfeldt-Jakob disease and other human transmissible spongiform encephalopathies.

A collaborative study of human transmissible spongiform encephalopathies has been carried out from 1993 to 2000 and includes data from 10 national registries, the majority in Western Europe. In this study, we present analyses of predictors of survival in sporadic (n = 2304), iatrogenic (n = 106) and variant Creutzfeldt-Jakob disease (n = 86) and in cases associated with mutations of the prion protein gene (n = 278), including Gerstmann-Sträussler-Scheinker syndrome (n = 24) and fatal familial insomnia (n = 41). Overall survival for each disease type was assessed by the Kaplan-Meier method and the multivariate analyses by the Cox proportional hazards model. In sporadic disease, longer survival was correlated with younger age at onset of illness, female gender, codon 129 heterozygosity, presence of CSF 14-3-3 protein and type 2a prion protein type. The ability to predict survival based on patient covariates is important for diagnosis and counselling, and the characterization of the survival distributions, in the absence of therapy, will be an important starting point for the assessment of potential therapeutic agents in the future.

Adolescent↗
PubMed2004

Sociodemographic differences in dietary habits in a population-based sample of elderly subjects: the 3C study.

PURPOSE: Diet plays an important role in maintaining quality of life in ageing and can be influenced by sociodemographic factors. We aimed to describe dietary habits in a large population-based sample of elderly people and to explore how they may vary according to sex, age, educational level and lifestyle. METHODS: 9250 community dwellers aged 65 years and over recruited in three French cities were interviewed about their food habits with a brief frequency questionnaire. For each food considered, the subjects were classified as occasional or regular consumers. Quantities of alcoholic beverages consumed daily were also assessed. Dietary habits were compared for men and women separately according each sociodemographic factor. RESULTS: Women were characterized by a more regular consumption of fruit and vegetables and drunk fewer alcoholic beverages. Older subjects ate meat, fish, cereals, raw vegetables and pulses less regularly. The proportion of regular consumers of fish, raw fruit, raw vegetables and cooked fruit or vegetables and the quantity of alcohol consumed increased with educational level. Subjects living alone were less regular consumers of almost all foods. DISCUSSION: The results show that even in a sub-population of elderly people, dietary patterns can vary greatly according to several factors. Identifying such factors is of value for future analytic studies on nutrition and health in the elderly. In view of dietary recommendations advising a high consumption of fruit and vegetables, subjects living alone and people with a low educational level are particularly at risk and should be encouraged to eat more balanced meals.

Aged↗
PubMed2002

Sporadic Creutzfeldt-Jakob disease and surgery: a case-control study using community controls.

BACKGROUND: The cause of sporadic Creutzfeldt-Jakob disease (CJD) is unknown. Previous studies found a link with a history of surgery but had methodologic problems. OBJECTIVE: To help elucidate medical and associated risk factors for sporadic CJD as part of the 1993 to 1995 European Union collaborative studies of CJD. METHODS: Medical and associated risk factors from 326 patients with sporadic CJD, taken from population-based studies performed between 1993 and 1995 in France, Germany, the Netherlands, and the UK, were compared with 326 community controls recruited by telephone in 2000. RESULTS: A history of surgery was significantly associated with the risk of sporadic CJD (odds ratio [OR]: 1.8; 95% CI: 1.2 to 2.6), which was not dependent on the number of surgical procedures, and was stronger in females (OR: 2.5; 95% CI: 1.5 to 4.0). Gynecologic (OR: 1.5; 95% CI: 1.0 to 2.3) and "other" operations (any operation other than neurologic, eye, ear, gallbladder, gastrointestinal, and gynecologic operations, tonsillectomy, and appendectomy) (OR: 1.5; 95% CI: 1.1 to 2.1) were associated with risk of CJD. Tonsillectomy (OR: 0.3; 95% CI: 0.2 to 0.5) and appendectomy (OR: 0.6; 95% CI: 0.4 to 0.8) were observed less frequently in cases. An increased risk was also found with a history of ear piercing in females (OR: 1.6; 95% CI: 1.1 to 2.5) and psychiatric visit(s) (OR: 2.6; 95% CI: 1.5 to 4.3). CONCLUSIONS: These results support the hypothesis that cases of sporadic CJD may result from hitherto unrecognized surgical contamination events. However, because of the limits of the study design, the rarity of the disease, and the potential for bias, the results should be interpreted with caution.

Aged↗
PubMed1998

Descriptive epidemiology of Creutzfeldt-Jakob disease in six European countries, 1993-1995. EU Collaborative Study Group for CJD.

After the occurrence of bovine spongiform encephalopathy (BSE), there has been concern that transmission of BSE to the human population might result in a change in the epidemiological characteristics of Creutzfeldt-Jakob disease (CJD). A collaborative study of CJD in the European Union was performed from 1993 to 1995, to compare data from national registries for CJD in France, Germany, Italy, The Netherlands, Slovakia, and the United Kingdom. Five hundred seventy-five patients with definite or probable CJD died in the study period with an overall annual mortality rate of 0.71 cases per million. The incidence rates for CJD were similar in all participating countries despite variations in postmortem rates, and age-specific incidence rates were also relatively consistent, with the exception of an increased incidence of CJD in patients younger than 39 years of age in the United Kingdom. In relation to etiological subtypes of CJD, 87% of cases were sporadic, 8% genetic, and 5% iatrogenic. Genetic forms of CJD comprised 80% of all cases in Slovakia, and iatrogenic forms of CJD occurred most frequently in France and the United Kingdom. The statistical data reported here do not provide evidence of a causal link between BSE and CJD in Europe as a whole. However, the study has established baseline epidemiological parameters for CJD in participating European countries, which may be important in the assessment of any future change in the characteristics of CJD as a result of the epidemic of BSE.

Adult↗
PubMed1998

Polymorphism of the prion protein is associated with cognitive impairment in the elderly: the EVA study.

BACKGROUND: Little is known about the role of the prion protein (PrP(sen)/gene PRNP). PRNP knockout mice studies suggest that PrP(sen) may be involved in CNS degeneration. This observation prompted us to examine the influence of PRNP genetic variability on cognitive abilities in the elderly. METHODS: In a community-based sample of 1,163 subjects aged 59 to 71 years, we characterized the valine (Val) and methionine (Met) allele of the PRNP polymorphism at codon 129. The effect of this polymorphism was estimated on the Mini-Mental State Examination (MMSE) and on a global composite score built from a battery of nine different neuropsychological tests. The results were adjusted for age, gender, education, and apolipoprotein E (apoE) polymorphism. RESULTS: Cognitive impairment (MMSE score < 24) was present in 2.5% of the Met-Met individuals, 2.9% of the Met-Val individuals, and 7.0% of Val-Val subjects (p = 0.02). Subjects homozygous for the PRNP Val allele had a lower MMSE and global score than the two other genotypes (p < 0.003). This effect was of the same magnitude as that of the apoE epsilon4 allele on cognitive performances. Both apoE epsilon4 and PRNP Val allelic effects were additive. CONCLUSION: This observation suggests that variability of the PRNP locus may be associated with cognitive performance in the elderly. This result, if confirmed, offers potential clues for the role of PRNP in the human brain.

Age Factors↗
PubMed1998

Demographic and cardiovascular risk factors in relation to antioxidant status: the EVA Study.

The aim of the study was to examine the determinants of blood antioxidant indicators on a large sample. Levels of plasma selenium and carotenoids, vitamin E in red blood cells, and thiobarbituric acid reactive substances (TBARS) were determined. The cross-sectional relationships between these markers and demographic and cardiovascular risk factors were examined in participants of the EVA study, a cohort of 1389 men and women, aged 59-71 years. Multivariable regression models including demographic (age, sex, socio-economic level), lifestyle (alcohol, tobacco), clinical and metabolic (lipids, glycemia) factors were used. Women had higher levels of plasma carotenoids, TBARS and red blood cell vitamin E. Cholesterol levels were positively associated to lipid-soluble vitamins, selenium and TBARS. Use of lipid-lowering drugs was positively associated with selenium and vitamin E and negatively with carotenoids. Body mass index was the strongest determinant of plasma carotenoids. Education and income levels were positively associated with selenium and total carotenoids. Tobacco consumption was negatively associated with red blood cell vitamin E, whereas alcohol consumption was positively associated with TBARS. This study emphasizes the respective place of the various determinants of antioxidant status. When considering tissue antioxidant indicators, analyses should take into account not only the metabolic parameters but also socio-economic factors and the subject's life style.

Aged↗
PubMed1997

The PREMAP Study: prevalence and risk factors of dementia and clinically diagnosed Alzheimer's disease in Provence, France. Prevalence of Alzheimer's Disease in Provence.

The PREMAP Study investigated the prevalence and risk factors of dementia and Alzheimer's Disease (AD) in a random sample of 1062 residents 70 year old or more, living in south-eastern France (private homes and institutions). All persons living in institutions for the elderly (n = 258) and community dwellers (n = 804) scoring less than 24 points on the MMSE (18.4%) were invited to undergo a medical evaluation at home by a qualified neurologist using the CERAD battery. We found 177 cases of dementia (9.2%), including 82 cases of AD (5.5%). Prevalence of AD increased significantly with age and was higher among women (OR: 4.24) and persons with no formal educational level (OR: 2.47). While a MMS score less than 24 was more frequent among persons with a foreign native language (OR: 3.05), the OR and AD was not significantly associated with native language. The proportion of AD among persons suffering from senile dementia was 45% among elderly living in institutions and 69% among those living in the community. Prevalence rates in south-eastern France are similar to the average rates for Europe. This study underlines the need to investigate the relationships between native language, MMSE and AD on the one hand, and the link between a low MMSE score and institutionalisation of patients suffering from AD on the other.

Aged↗
PubMed1996

A new variant of Creutzfeldt-Jakob disease in the UK.

BACKGROUND: Epidemiological surveillance of Creutzfeldt-Jakob disease (CJD) was reinstituted in the UK in 1990 to identify any changes in the occurrence of this disease after the epidemic of bovine spongiform encephalopathy (BSE) in cattle. METHODS: Case ascertainment of CJD was mostly by direct referral from neurologists and neuropathologists. Death certificates on which CJD was mentioned were also obtained. Clinical details were obtained for all referred cases, and information on potential risk factors for CJD was obtained by a standard questionnaire administered to patients' relatives. Neuropathological examination was carried out on approximately 70% of suspect cases. Epidemiological studies of CJD using similar methodology to the UK study have been carried out in France, Germany, Italy, and the Netherlands between 1993 and 1995. FINDINGS: Ten cases of CJD have been identified in the UK in recent months with a new neuropathological profile. Other consistent features that are unusual include the young age of the cases, clinical findings, and the absence of the electroencephalogram features typical for CJD. Similar cases have not been identified in other countries in the European surveillance system. INTERPRETATION: These cases appear to represent a new variant of CJD, which may be unique to the UK. This raises the possibility that they are causally linked to BSE. Although this may be the most plausible explanation for this cluster of cases, a link with BSE cannot be confirmed on the basis of this evidence alone. It is essential to obtain further information on the current and past clinical and neuropathological profiles of CJD in the UK and elsewhere.

Adolescent↗
PubMed1996

Relation of serum elastase activity to ultrasonographically assessed carotid artery wall lesions and cardiovascular risk factors. The EVA study.

The potential interest of serum elastase activity (SEA) as a marker of vascular aging and atherosclerosis was studied as part of an epidemiological study on vascular and cognitive aging (EVA Study). SEA was measured in 555 men and 774 women aged 59-71 years with a synthetic substrate, suc(ala)3pNA, according to a modified enzyme-linked immunosorbant assay (ELISA)-type procedure. The distribution of SEA-values was skewed to the right in men and women, the mean value was 0.52 +/- 0.55 U/ml in males and 0.43 +/- 0.52 U/ml for females. This difference could be entirely explained by alcohol consumption. SEA increased strongly with alcohol consumption in males and females. It was also positively and significantly correlated with body mass index (BMI) and systolic blood pressure (SBP). SEA significantly decreased with age in men and was not influenced by smoking in either sex. SEA was significantly increased in diabetic men compared with non-diabetics and a similar trend, although not significant, was observed in women. When both sexes were combined, the association between diabetes and SEA was independent of other clinical risk factors. No significant associations were observed with intima-media thickness or atherosclerotic plaques assessed by B-mode carotid ultrasonography. Among biological risk factors, triglycerides (in both sexes) and glucose (in men) appeared the strongest correlates of increase in SEA. In multivariate analysis, independent determinants of an increased SEA were age, alcohol consumption, triglycerides and glucose in men, and alcohol consumption and triglycerides in women.

Aged↗
PubMed1996

Ultrasonographic assessment of carotid wall characteristics and cognitive functions in a community sample of 59- to 71-year-olds. The EVA Study Group.

BACKGROUND AND PURPOSE: This study was aimed at analyzing cross-sectional relationships between cognitive performance and ultrasonographic assessment of carotid wall characteristics. METHODS: A cohort of 1279 subjects (men, 41%) aged 59 to 71 years was recruited from the electoral rolls of the city of Nantes (western France). Cognitive performances were evaluated with the Mini-Mental State Examination (MMSE) and seven neuropsychological tests assessing attention, psychomotor rapidity, verbal abilities, memory, and visuospatial perception. For each test, subjects were classified into three performance levels with a quartile distribution: 25% highest, 25% lowest, and 50% middle. The intima-media thickness of common carotid arteries and the presence of plaques in the carotid arteries were assessed with B-mode ultrasound examination. RESULTS: Only 28% of men and 17% of women had carotid plaques inducing moderate stenosis of the lumen ( < 40%). After adjustment for possible confounders, odds ratios for poor cognitive performance associated with plaques were above 1 for all cognitive tests in men. This association was statistically significant for the MMSE and another test assessing attention skills. There was a slight association between increase of the common carotid intima-media thickness and poor cognitive scores in men with plaques. In women, no association was found between cognitive functions and presence of plaques or intima-media thickness. CONCLUSIONS: This study indicated a moderate association between atherosclerosis of the carotid arteries and poor cognitive functioning in men aged 59 to 71 years. In view of these moderate cross-sectional results, further studies are required to better assess the relationship between carotid atherosclerosis and cognitive impairment.

Aged↗
PubMed1995

[Epidemiology of Creutzfeldt-Jakob disease].

Creutzfeldt-Jakob disease is a rare disease (incidence < 1 case per million inhabitants), reported in all continents. Certain characteristics are constant from one country to another: mean age of onset: 65 years, duration of the disease: about 6 months, sex ratio close to 1 and approximately 10% of familial cases. The geographical sites of this disease identified in Chile, Israel and Czechoslovakia suggest certain genetic and/or environmental risk factors. The principal environmental factor implicated is scrapie in sheep, especially in these regions. Genetic studies have demonstrated the presence of apparently causal mutations of the PrP gene and a high risk of CJD associated with certain normal polymorphisms of this gene (codon 129). Certain grafts (dura mater, cornea) and treatment by extracted growth hormone are responsible for iatrogenic transmission. Multicentre epidemiological studies recruiting a large number of cases are needed to define the risk factors of this disease.

Creutzfeldt-Jakob Syndrome↗
PubMed1995

[Elastolysis, aging and atherogenesis].

In order to explore the potential role and importance of elastin fiber degradation in atherogenesis we determined in more than 1,400 individuals (males and females between 59 and 71 years of age), [the EVA epidemiological study] serum parameters related to elastin fiber degradation: serum elastase activity, circulating elastin peptides and serum elastase inhibitor titers. Significant correlations were found these between parameters and several other serum constituents considered as risk-factors of atherogenesis--essentially serum lipid-parameters and glycemia as well as several other biological factors. These correlations confirm the validity of the underlying hypothesis concerning the interest of the clinical determinations of these elastin-related parameters and the potential role of the permanent activation of the endothelial elastin-receptor in atherogenesis.

Aged↗