PubMed Health⌕ Search

Biomedical subjects

Anne-Sophie Rigaud

Publications and source records attributed to Anne-Sophie Rigaud.

14 recordsLinked to original sources
PubMed2005

Relationship between arterial stiffness and cognitive function in elderly subjects with complaints of memory loss.

BACKGROUND AND PURPOSE: To evaluate the relationship between arterial stiffness and cognitive function in a population of elderly subjects reporting memory loss. METHODS: We studied the association between cognitive function and arterial stiffness in 308 consecutive elderly subjects attending a geriatric outpatient clinic reporting memory impairment. Subjects were classified into 4 categories according to neuropsychological evaluation: normal cognitive function, mild cognitive impairment (MCI), Alzheimer disease (AD), or vascular dementia (VaD). Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (PWV) measurement using Complior. RESULTS: In this population, 78+/-8 years of age (women 64%), AD was present in 41%, VaD in 6%, MCI in 27%, and 26% of subjects had normal cognitive function. After adjustment for age, gender, systolic blood pressure, education level, cardiovascular diseases, and antihypertensive therapy, a significant association was observed between PWV and cognitive status (P<0.0001). PWV appears significantly higher in subjects with VaD (15.2+/-3.9 m/s) or AD (13.3+/-2.9 m/s) than in those without cognitive impairment (11.5+/-2.0 m/s; P<0.001). Moreover, PWV was higher in subjects with MCI (12.6+/-2.6 m/s) than in those without cognitive impairment (11.5+/-2.0 m/s; P=0.01). For each 2 m/s increment in PWV, the adjusted odds ratio (95% CI) was 1.73 (1.27 to 2.47) for AD and 3.52 (1.87 to 8.05) for VaD. CONCLUSIONS: Our results showed a relationship between arterial stiffness and cognitive impairment, suggesting that functional changes of the arterial system could be involved in the onset of dementia (VaD or AD types).

Age Factors↗
PubMed2004

Patterns of memory impairment and perseverative behavior discriminate early Alzheimer's disease from subcortical vascular dementia.

Previous research suggests that the neuropsychological deficits in Alzheimer's disease (AD) are different from that of vascular dementia (VaD), especially with respect to memory, language and executive functions, but negative findings were reported. Our objective was to clarify the cognitive syndrome in AD and VaD in the early stage of these disorders. We investigated 45 patients with early AD, 23 patients with subcortical VaD and 35 normal controls. All subjects were assessed with neuropsychological battery designed to measure memory, language, praxis and executive functions. Patients with AD had significantly worse scores on Story Recall (p<0.02) and on all measures of the Free and Cued Selective Reminding Test (p<0.03 to 0.001) than did patients with VaD, as well as greater number of perseverations (p<0.02) on category fluency. Conversely, VaD patients had more perseverations (p<0.02) on the Modified Card Sorting Test. Despite the similar degree of overall cognitive deterioration, the findings show more impaired retrieval from long-term storage in AD than in VaD. Moreover, the data suggest that AD and subcortical VaD affect perseverative behavior in a different fashion. These results may be helpful in differentiating AD from VaD in the early stage of these disorders, when mental impairments are not pervasive yet.

Aged↗
PubMed2003

[Oestro-progestagen treatment combined with rivastigmine in menopausal women suffering from Alzheimer's disease. The results of a 28-weeks controlled study].

OBJECTIVE: To compare the efficacy on cognitive function of the combination of hormone replacement therapy with rivastigmine, acetylcholinesterase inhibitor, in menopausal women suffering from mild to moderately severe Alzheimer's disease. METHOD: This was a randomised double blind study of 117 women suffering from mild to moderately severe Alzheimer-like dementia (MMSE between 10 and 26). The patients were randomly assigned to continuous hormone therapy (n=59) and placebo (n=58), all receiving treatment with rivastigmine. Follow-up was of 28 weeks. ASSESSMENT CRITERIA: ADAS-Cog (Alzheimer's disease assessment scale--cognitive subscale) (primary endpoint); MMSE (mini mental state examination), GDS (global deterioration scale), CGC-Plus (clinical global change-plus), NPI (neuropsychiatric inventory), IADL (instrumental activities of daily living). Data regarding tolerance was recorded. RESULTS: No significant difference was observed in the parameters assessing efficacy (cognitive function, global assessment, functioning, neuropsychiatric symptoms) and tolerance between the two groups of treatment. CONCLUSION: Oestro-progestagen treatment did not provide further improvement when combined with rivastigmine during mild to moderately severe Alzheimer's disease.

Aged↗
PubMed2003

[Epidemiology of depression in patients with Alzheimer's disease and in their caregivers].

DEPRESSION IN THE PATIENT: Signs of depression in patients with Alzheimer's disease are difficult to detect because they change over time and vary in intensity and duration. Estimated frequency depends greatly on the evaluation scale (Cornell scale, Geriatric Depression Scale, Behave-Alzheimer disease scale, Cohen-Mansfield scale, Neuropsychiatric Inventory (NPI)). Several risk factors have been identified including early age of disease onset, female gender, etc). The anatomic basis of depression is essentially related to the noradrenergic and serotoninergic systems. DEPRESSION IN THE CAREGIVER: Caregivers bear a heavy burden, psychologically (30-50% of all cases of depression), physically, and financially. Depression in the caregiver favors depression in the patient, and vice versa. Episodes may develop at any time during the disease course. Decompensation depends on both patient-related and caregiver-related factors. IMPORTANCE OF DETECTING DEPRESSION: Depression is frequent, both in the patient and in the caregiver and must be detected and treated early. It has been demonstrated that 50% of the caregivers may be affected, but only 10-20% are treated.

Aged↗
PubMed2003

Patients with Alzheimer's disease living at home in France: costs and consequences of the disease.

Alzheimer's disease (AD) creates a substantial burden on human and financial resources. However, there are few data relating to the cost of AD in France. This retrospective study assesses the total costs of caring for home-based patients with mild to moderate AD. Pattern of care, sociodemographic data, caregiver burden, and estimated net costs of caring for AD patients were assessed in a stratified sample of 50 untreated AD patients. The net costs of caring for all AD patients who completed all study parameters increased with decreasing cognitive ability. Unpaid assistance was the most costly component of the total cost of care. Mini-Mental State Examination scores correlated strongly with functional status, and instrumental activities of daily living scores were a robust indicator of the magnitude of behavioral, cognitive, and dependence problems. This study suggested a significant link between costs of caring for an AD patient at home and disease severity.

Activities of Daily Living↗
PubMed2002

Apolipoprotein E epsilon 4 allele frequency in demented and cognitively impaired patients with and without cerebrovascular disease.

Controversy exists regarding the apolipoprotein E (ApoE) epsilon 4 allele association with vascular dementia (VaD). The results range from increased epsilon 4 frequency, similar to that found for Alzheimer's disease (AD), to no association at all. Our objective was to clarify the relationship between ApoE epsilon 4 allele and cerebrovascular disease (CVD) in demented and cognitively impaired patients. We examined the ApoE phenotypes in a sample of 452 subjects: 219 with AD, 45 with VaD, 62 with mixed dementia (MD), 45 with mild cognitive impairment (MCI) without CVD, 27 in which vascular disease was the most probable cause of cognitive decline (vascular mild cognitive impairment, VMCI) and 54 normal controls (NC). The study of the epsilon 4 allele frequency showed significant differences between: AD group and the VaD, VMCI and NC groups; MCI group compared with VMCI and NC groups; and MD group versus the VaD and NC groups (p<0.05-0.0001). The frequency of the epsilon 4 allele in the VaD and VMCI groups did not differ significantly from NC. In contrast to other studies, we did not detect a relationship between ApoE epsilon 4 allele and clinically diagnosed VaD. Our results also show that the epsilon 4 allele is not associated with cognitive impairment of vascular origin. In addition, we have confirmed that the ApoE epsilon 4 allele occurs frequently in late-onset AD and we have found similar association in cognitively impaired individuals without clinical CVD. These findings should contribute to the assessment of dementia risk profile in the elderly.

Aged↗
PubMed2002

[Difficulty in assessing renal function in elderly hypertensive patients. Results of a survey in the geriatric environment].

OBJECTIVES: In elderly patients, modifications observed in renal function often make difficult the differentiation between the pathological cause and the physiological consequences of aging. The presence of arterial hypertension can enhance these hemodynamic modifications. The state of renal function is often assessed only on creatinemia, which is not a marker adapted to the elderly, since creatinine levels often remain normal even in cases of altered renal function. The aim of this study was to determine the prevalence of chronic renal failure (CRF) in elderly hypertensive patients, based on the calculation of creatinine clearance using Cockcroft and Gault's method, and comparing it with the prevalence of CRF when renal function is assessed by methods currently used by practitioners. METHODS: In 841 treated hypertensive patients aged over 65, hospitalized in geriatric wards (median or long term hospitalization), the state of renal function was assessed in two ways: on the one hand by the physicians themselves, according to their method of choice and, on the other, by calculating creatinine clearance according to Cockcroft and Gault's method. These assessments were then compared and the main conflicting factors were revealed by logistics regression. Furthermore, the importance given to the state of renal function in the therapeutic attitude of the physician was determined using a graduated scale from 0 to 5. Logistics regression analysis identified the principle determinants of this attitude. RESULTS: In this population with a mean age of 81 +/- 8 years, predominantly composed of women (65%), the prevalence of renal failure (clearance calculated according to Cockcroft and Gault's formula < 80 ml/min) was of 89%, and of 42% at the stage of severe or pre-terminal renal failure (clearance < 30 ml/min). Conversely, when assessed by the physicians according to their method of choice, it was only of 64% and 16% respectively. The agreement between calculated and assessed renal function was of 35%. Renal damage is often underestimated by the physicians compared with calculated values (for 61% of patients). Logistics regression revealed the following determinating discrepancies: gender (p = 0.0001), age (p = 0.0025) and body weight (p = 0.0031), which are the principle variables of Cockcroft and Gault's formula. The principle elements taken into account in the assessment of renal function in the therapeutic attitude of the physicians towards these elderly patients are: the existence of an alteration in renal function (p = 0.0001), the level of systolic arterial pressure (p = 0.001), the number of cardiovascular risk factors (p = 0.002), notably diabetes (p = 0.003) and the female gender (p = 0.024). CONCLUSIONS: This study emphasizes the great prevalence of renal failure in elderly hypertensive patients, with only 11% of hypertensive patients exhibiting normal renal function after the age of 80. Assessment of renal function by the physicians according to their method of choice suggests an underestimation of renal damage compared with the calculated values of creatinine clearance. Availability of simple calculation tools would facilitate the systematic application of Cockcroft and Gault's formula and provide enhanced appreciation of renal function in the elderly.

Aged↗
PubMed2002

Antihypertensive drugs and cognitive function.

The increase in life expectancy is associated with a sharp rise in cognitive disorders, particularly after the age of 80 years. The identification and management of risk factors for these invalidating and distressing conditions must be considered a priority. Hypertension has been shown to carry an increased risk not only for cerebrovascular morbidity and mortality, but also for cognitive impairment and dementia. The fact that antihypertensive treatment has been demonstrated to decrease those risks offers a new opportunity to reduce the prevalence of such related disorders and to promote healthy aging.

Age Factors↗
PubMed2002

Presence or absence of at least one epsilon 4 allele and gender are not predictive for the response to donepezil treatment in Alzheimer's disease.

The objective was to evaluate the effects of the apolipoprotein E (ApoE) genotype and gender on the response to donepezil treatment in Alzheimer's disease. ApoE genotyping was performed on 117 patients with mild to moderate Alzheimer's disease who were included in a 36-week open label trial of donepezil therapy. Of these 117 patients, who constituted the intent-to-treat population (ITT), 80 completed the trial, and constituted the evaluable population. Patients were treated blindly in relation to ApoE genotype. Outcome measures were Alzheimer's disease Assessment Scale-Cognitive Component (ADAS-Cog), the Mini Mental State Examination, Instrumental Activities of Daily Living, and the Caregiver-rated Clinical Global Impression of Change. ITT analysis did not reveal significant differences between the responses of epsilon 4- and epsilon 4+ carriers according to the ADAS-Cog (P = 0.28). No differences were found either between the responses of men and women (P = 0.81), and there was no significant interaction between genotype and gender (P = 0.09). Other outcome measures all exhibited similar patterns of change to those seen using the ADAS-Cog. Consequently, these results do not support the hypothesis that the ApoE phenotype and gender are predictors of the response to donepezil in Alzheimer's disease patients.

Aged↗
PubMed2002

Neuropsychological deficit in early subcortical vascular dementia: comparison to Alzheimer's disease.

To further clarify the cognitive syndrome in subcortical vascular dementia (VaD), we investigated 20 patients with early-stage VaD as compared with 30 patients with Alzheimer's disease (AD) and 22 normal controls using episodic memory, attention/executive function and language tests. The patient groups were closely matched in terms of age, education and severity of dementia. The VaD patients had a significantly better free recall, cued recall and recognition memory than AD patients, the recognition being within normal limits in VaD. In addition, VaD patients had a greater number of perseverative errors during the Modified Card Sorting test, while AD patients exhibited more perseverations of semantic fluency. The results of retrieval deficit syndrome and increased number of perseverations during tasks sensitive to frontal lobe function are in agreement with the studies emphasizing the importance of frontal dysfunction in subcortical VaD. These findings are relevant for the early diagnosis of VaD and might be useful in the differential diagnosis with AD.

Aged↗
PubMed2002

Efficacy and safety of memantine in patients with mild to moderate vascular dementia: a randomized, placebo-controlled trial (MMM 300).

BACKGROUND AND PURPOSE: Based on the hypothesis of glutamate-induced neurotoxicity (excitotoxicity) in cerebral ischemia, this study examined the efficacy and tolerability of memantine, an uncompetitive N-methyl-D-aspartate antagonist, in the treatment of mild to moderate vascular dementia. METHODS: In this multicenter, 28-week trial carried out in France, 321 patients received 10 mg/d memantine or placebo twice a day; 288 patients were valid for intent-to-treat analysis. Patients had to meet the criteria for probable vascular dementia and have a Mini-Mental State (MMSE) score between 12 and 20 at inclusion. The 2 primary end points were the cognitive subscale of the Alzheimers Disease Assessment Scale (ADAS-cog) and the global Clinician's Interview Based Impression of Change (CIBIC-plus). RESULTS: After 28 weeks, the mean ADAS-cog scores were significantly improved relative to placebo. In the intention-to-treat population, the memantine group mean score had gained an average of 0.4 points, whereas the placebo group mean score had declined by 1.6 points, ie, a difference of 2.0 points (95% confidence interval, 0.49 to 3.60). The response rate for CIBIC-plus, defined as improved or stable, was 60% with memantine compared with 52% with placebo (P=0.227, intention to treat). Among the secondary efficacy parameters, which were analyzed in the per-protocol subset, MMSE was significantly improved with memantine compared with deterioration with placebo (P=0.003). The Gottfries-Brane-Steen Scale intellectual function subscore and the Nurses' Observation Scale for Geriatric Patients disturbing behavior dimension also showed differences in favor of memantine (P=0.04 and P=0.07, respectively). Memantine was well tolerated with a frequency of adverse events comparable to placebo. CONCLUSIONS: In patients with mild to moderate vascular dementia, memantine 20 mg/d improved cognition consistently across different cognitive scales, with at least no deterioration in global functioning and behavior. It was devoid of concerning side effects.

Aged↗
PubMedDate not supplied

Disclosure of diagnosis of Alzheimer's disease in French general practice.

Most practitioners find disclosing the diagnosis of Alzheimer s disease (AD) to an individual with dementia very difficult. Literature results show a wide variability in attitudes and clinicalpractice, and diagnosis seems to be more often disclosed to caregivers than to patients. The objective of this study was to examine whether and how diagnosis of AD is disclosed in French general practice and which issues are addressed with the patient. A questionnaire was sent via mail to 1,629 general practitioners (GPs), 1,105 belonging to the Sentinel's network and 524 specially recruited doctors practicing in the Rhône-Alpes region. A total of 631 questionnaires were returned (response rate, 39 percent), of which 616 were eligible for analysis. Twenty-eight percent of GPs reported having disclosed diagnosis to the patient (25 percent mentioned "Alzheimer's disease"), whereas 88 percent considered it their role to announce the diagnosis to the patient. Regarding the type of information provided to the patient, only 25 percent discussed the nature of the illness, 23 percent behavioral problems, and 47 percent depression, mainly for psychological reasons (63 percent). Stress was discussed with 79 percent of the caregivers. We concluded that GPs do not discuss the consquences of AD and symptoms (e.g., behavioral disorders) with patients, mainly for psychological reasons, whereas they have a less-reluctant attitude toward caregivers. As the GP has the weighty task of providing ropriate community care and psychological support to the patient, it is of utmost importance to reflect on how disclosure of diagnosis can be facilitated.

Alzheimer Disease↗