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Biomedical subjects

B Vellas

Publications and source records attributed to B Vellas.

At least 19 recordsLinked to original sources
PubMed2003

[Association between the A2 allele of the HLA system and age at onset of Alzheimer's disease].

OBJECTIVE: Alzheimer is a multifactor disease occurring in a sensitive genetic territory. The e4 allele of the apolipoprotein E (APO E) is a recognised factor of risk. Some studies have suggested an association between the A2 allele of the HLA system and an earlier onset of the disease notably when it appears before the age of 64 or after the age of 75. The aim of our study was to explore this hypothesis in an independent sample of patients. METHODS: We compared the influence of the A2 allele of the HLA system on the age at onset of the disease in two groups of Caucasian patients presenting with Alzheimer's disease: early onset if the disease appeared before the age of 60 (n= 31) and late onset if it had appeared after the age of 75 (n= 44). The influence of the e4 allele of APO E was also taken into account. RESULTS: The comparison of the patients depending on the presence or not of at least one HLA-A2 allele revealed no significant difference, whatever the group of patients studied, in the age at onset of the disease. CONCLUSION: The age at onset of Alzheimer's disease was not influenced in our study by the presence of the HLA-A2 allele.

Age Factors↗
PubMed2003

Role of behavioural disturbance in the loss of autonomy for activities of daily living in Alzheimer patients.

BACKGROUND: Cognitive impairment is associated with functional impairment in patients with Alzheimer's disease (AD). Behavioural disturbance is very common in these patients. Nevertheless, there has been very little research into the relations between behavioural disturbance and functional status in AD. The purpose of this study is to investigate the relationship between behavioural disturbance and functional status after taking account of cognitive impairment. MATERIAL AND METHODS: 579 patients were prospectively evaluated at 16 French hospitals, all referents for AD, and were diagnosed with possible or probable AD. These patients were assessed with NeuroPsychiatric Inventory (NPI), cognitive subscales of the Alzheimer's Disease Assessment Scale (ADAS-cog), Clinical Dementia Rating scale (CDR) and Instrumental Activities of Daily Living scale (IADL). RESULTS: The number of men with available data for IADL total score was too small to make any analysis. 'Group A' gathered 256 women for whom the relation between autonomy for Activities of Daily Living (ADL) and the other variables were determined. 'Group B', pooled 85 women for whom relations found were verified. Linear regression was used for the analysis. With age, cognitive impairment allows us to explain best (38%) the loss of autonomy for ADL. CONCLUSION: The role of behavioural disturbances in the loss of autonomy for ADL was not determinant in our study, whereas cognitive impairment and age were better able to determine the loss of autonomy for ADL. Further study is needed to explain the decline of functional status in AD patients.

Activities of Daily Living↗
PubMed2003

[The French network multicenter study. Predictive factors of hospitalization and management of Alzheimer's disease patients (REAL.FR)].

We present in this article the REAL.FR research program on Alzheimer disease (AD) and its management. This is a French multicenter prospective study whose objectives are to study the natural history of AD and the modalities of its management. In order to pursue these aims, we set up a cohort of 700 AD patients in France. They entered the study in year 2000 and will be followed for at least four years. The study population consists of AD patients, living in the community at the time of enrollment and looked after by an informal caregiver. On inclusion, each patient underwent a full investigation which included gerontological and social evaluation. Patients will be seen every six months for at least four years. During follow-up, events which have occurred during the previous six months are noted (i.e. admissions to hospital or to an institution, use of new in-home help services...). To date, 577 patients have been reviewed at 6 month, 489 at 12 month, 358 at 18 month, 266 at 24 month, 178 at 30 month and 31 at 36 month. 48 death have been registered, 42 patients have been institutionalised and 124 have been dropped out. Mean age of patients on inclusion was 77.4 +/- 7 years. Nearly one-third of patients were living at home when they were enrolled in the study. Our preliminary results are encouraging regarding the feasibility of patients follow-up. The satisfactory participation of patients and their families in the later evaluations which have already been carried out also seem promising for the continuation of follow-up.

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PubMed2003

[Clinical evaluation of dementia in a cohort of 358 patients with the French version of the Clinical Dementia Rating (CDR) scale].

PURPOSE: A reliable global rating of dementia severity in Alzheimer's disease is critical both in clinical and research practice. In this paper, we present the results of the assessment of a cohort of 358 patients using the French version of the Clinical Dementia Rating Scale (CDR). METHODS: 358 patients from a multicentric cohort were assessed in a comprehensive way: cognitive (Mini Mental Status Examination), functional (Activities of Daily Living), behavioural (Neuro Psychiatric Inventory) and global (Global Dementia Scale). CDR staging was performed after both patient and caregiver interview. RESULTS: 27.6% of the patient had a CDR 0.5 (questionable dementia), 43% CDR 1 (mild dementia), 24.9% CDR 2 (moderate dementia) and 4.5% CDR 3 (severe dementia). All the rating scales were highly correlated with CDR stages (p < 0.0001). The CDR was also correlated with the Global Dementia Scale (p < 0.0001), but a perfect overlap of individual stages was not achieved. CONCLUSIONS: CDR staging takes into account the major domains of dementia assessment: cognition, function and behaviour. Staging Alzheimer's patients as CDR 0.5 arises the issue of the relationship between very mild dementia and Mild Cognitive Impairment. This study represents the first step of the CDR (French version) validation which is underway in this cohort.

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PubMed2003

[Vascular risk factors and Alzheimer's disease].

BACKGROUND AND OBJECTIVE: Recent epidemiological study and clinico-pathologic data suggest overlaps between Alzheimer disease and cerebrovascular lesions that may magnify the effect of mild Alzheimer disease pathology and promote progression of cognitive decline. There is now strong epidemiologic evidence supporting an association between Alzheimer disease and two major vascular risk factors--blood pressure and diabetes. The major objective of this study is to analyse the impact of vascular risk factors on natural history of Alzheimer's disease. METHODS: Descriptive analyse of the vascular risk factors on 520 Alzheimer's disease patients issue from the population of the "Programme Hospitalier de Recherche Clinique: "Réseau sur la maladie d'Alzheimer français". RESULTS: The description of the vascular risk factors in the Alzheimer's disease patients from the "Programme Hospitalier de Recherche Clinique. "Réseau sur la maladie d'Alzheimer Français" was made and the projects and perspectives of analyses based on the longitudinal data were discussed. 45% of subjects have high blood pressure, they were significantly older (p < 0.05), have more frequent impairment of ADLs (p < 0.05), and one-leg balance impairment (p < 0.05). 10% of patients have diabetes and 23.95% hypercholesterolemia. CONCLUSIONS: The first data on vascular risk factors of the "Programme Hospitalier de Recherche Clinique: "Réseau sur la maladie d'Alzheimer français"" are the first step on comprehension of the impact of vascular risk factors and their traitments on Alzheimer's disease.

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PubMed2003

[Patients with Alzheimer's disease living alone at home in the cohort of REAL.FR].

OBJECTIVE: Despite the French population's growing, we reported an increasing numbers of older adults living alone and an increasing number of older adults with Alzheimer's disease. Social and medical problems may be exacerbated with subjects with both phenomena. The objective is to identify differences in patterns between persons with dementia who live alone versus living with some people at home. METHOD: 700 subjects with mild to moderate Alzheimer's disease from the French Alzheimer network (REAL.FR). We studied social and demographic feature, nutritional and cognitive statute and a comprehensive geriatric assessment. RESULTS: In this study, 28% of subjects with probable or possible Alzheimer's disease live alone. They are more likely to be women (p < 0.001) with few physical impairments (p < 0.02). Subject are more frailty: lower incomes, impairment in the nutritional status and balance, and are more likely to use medical and non medical services (p < 0.0001). They are more likely to be malnourished than the others. On the other hand, there is no association between disability's cognitive levels and living alone. CONCLUSION: We need longitudinal survey to follow up this population to determine predicting factors for keeping them alone at home and to anticipate long-term care placement.

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PubMed2003

[Clinical features of ambulatory patients over 80 years of age followed for Alzheimer's disease. French prospective multicenter study REAL.FR].

PURPOSE: Twice out off three, patients with Alzheimer's disease (AD) are aged 80 and older. Very old patients are more frail, have social precariousness and have often polypathology. Few data are available about these elderly patients. The aim of our study was to analyse characteristics of AD patients aged 80 and older. MATERIAL AND METHODS: This is a prospective, multicentric French study (REAL.FR) of a cohort of ambulatory AD patients, with Mini-Mental State values between 10 and 26. Clinical and social data at inclusion of patients aged 80 and older and patients younger were compared. RESULTS: Six hundred eighty nine patients (488 women, 201 men) were included between April 2000 and June 2002. The mean age was 77.8 +/- 6.9 years. Two hundred sixty four patients (38%) were aged 80 and older. Those patients were more dependant for Activities of Daily Living (ADL) than younger patients (ADL score of Katz: 5.2 +/- 1.07 et 5.6 +/- 0.74 respectively; p < 0.001 and IADL (Instrumental Activities of Daily Living) score of Lawton: 7.3 +/- 3.57 et 9.3 +/- 1.57 respectively; p < 0.001). Duration of evolution of the disease were comparable between older and younger patients. CONCLUSION: In our cohort, AD patients aged 80 and older had a weakest autonomy for the ADL than younger patients with the same stage of the disease. Results has implications on care. Following the cohort will permit to specify evolution of data.

Activities of Daily Living↗
PubMed2003

[Depressive symptoms in Alzheimer's disease: preliminary results of the REAL.FR study].

UNLABELLED: The Alzheimer's disease (AD) is today regarded as a degenerative pathology with a serious and common complication: occurrence of mental and behavioral disturbances. Among this neuropsychiatrics symptoms, the depressive symptoms occupy a significant place by their frequency and their consequences on the caregiver's burden. The prevalence of such disorders is very variously appreciated in the literature. OBJECTIVE: To assess with precision depressive symptoms in a population with Alzheimer's disease rated on neuropsychiatric inventory NPI. METHOD: Cross-sectional study of patients with AD presenting at the consultation of psycho-geriatic, geriatric or neurologic services in 16 french university hospitals. The frequency of the depression was evaluated with the NPI on a population of 578 subjects with AD. We studied the association existing between these symptoms and the antecedents of depression and we studied the gravity of these disorders according to the cognitive status. RESULTS: Caregivers describe less one depressive symptom for approximately 40% of the subjects included in the study n = 229. The average score of gravity is close to 4 and is thus clinically significant. More the stage of dementia is severe more the number of subjects presenting a clinically significant score is important. Scores of depression evolve parallel to the stage of dementia. The antecedents of depression are a risk factor for depressive symptoms in the AD p < 0.001. DISCUSSION: These results confirm those of primary studies. In our study, more than the prevalence of depressive symptoms it seems that is the severity of the disorder which is associated with the dementia severity. The continuation of this work will allow a prospective evaluation of depressive symptoms in the AD.

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PubMed2003

[Wandering and Alzheimer's type disease. Descriptive study. REAL.FR research program on Alzheimer's disease and management].

PURPOSE: Wandering is a common problem among patients with Alzheimer's disease. Few studies have examined this problematic behaviour in the community. The aim of the present study was to increase our understanding of wandering during Alzheimer's disease in subjects living in the community. METHODS: We studied 571 patients with Alzheimer's disease living in the community. Objective cognitive status was assessed using a series of standardized neuropsychological tests. Nutritional assessment, risk of fall, autonomy were assessed as well as the burden of their family. The behavioural abnormalities of patients were assessed with their caregiver using the Neuro-Psychiatric Inventory. Patients with or without wandering were described. RESULTS: Prevalence of wandering was 12.6%. Patients with wandering appeared to have more severe cognitive impairment, less autonomy and were undernourished. Behavioural and psychological signs significantly associated with wandering were delirium, aggressiveness, irritability, depression, anxiety, euphoria, apathy, desinhibition and eating behaviour disorder. Subtype of Alzheimer's disease patients seemed to have frontal release behaviour. CONCLUSION: Wandering is a common behaviour in Alzheimer's disease patients living in the community. Special care must be organized to help those frail patients and their caregivers.

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PubMed2003

[Factors associated with the moderately severe stage of Alzheimer's disease: first results of the REAL.FR study].

OBJECTIVE: Most studies of Alzheimer's disease deal with the mild to moderate stages of the disease. However the great majority of cases evolve toward a stage of marked severity which can last many years. The few studies of severe dementia that have been carried out have included institutionalized patients. The aim of this study is to describe associated factors with a moderately severe Alzheimer's disease in a French community dwelling patients. METHODS: Initial data from a French cohort Study of Alzheimer's patients (REAL.FR: Réseau sur la maladie d'Alzheimer français) were analysed. These included sociodemographic and medical factors and measures of cognitive and non cognitive performance. We compared two groups according the stage of the disease: moderately severe patients (Mini Mental Status score < 15) and mild to moderate patients (Mini Mental Status score > or = 15). RESULTS: Moderately severe stage of disease was independently related to age (OR: 0.35; 95% CI: 0.16-0.78 for patient aged between 75-80 years compared to patient < or = 75 years), low educational level (non-obtention of french certificate of primary education, OR: 2.43; IC à 95%: 1.28-4.59) and disability to perform activities of daily living (OR: 3.35; 95% CI: 1.62-6.93). After multivariate analysis, there was no difference between the 2 groups for the other factors like behavioral symptoms. CONCLUSIONS: Severe dementia represents major medical and socio-economical problem. Better knowledge of the natural history of the severe stage of the disease is necessary for better clinical practice.

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PubMed2003

[Rapid loss of the Mini Mental State Examination: REAL.FR study].

BACKGROUND: Alzheimer's disease is a chronic pathology requiring regular follow-up. The predictive factors of rapid cognitive decline remain unclear. OBJECTIVES: To analyse the baselines characteristics of patients at increased risk of rapid cognitive decline. METHODS: This study presents transversal data on a community-based sample of 340 patients diagnosed with probable Alzheimer's disease and followed by REAL.FR group. Rapid cognitive decline was defined as a 3-points or greater loss on the Mini Mental State Examination (MMSE) within six months. RESULTS: 54% of patients presented a rapid cognitive decline. Logistic regression analysis showed a positive association between rapid cognitive decline and a MMSE < or = 20 (p < 0.003) or a greater BMI (p < 0.02) and a tendency towards a negative correlation with anxiety (p = 0.06) and negative correlation with the burden severity (p < 0.05). CONCLUSIONS: Patients with a worse cognitive status, a greater BMI and less anxiety or burden were at increased risk of rapid cognitive decline. Future studies should focus on determining etiologies for patients with rapid cognitive loss and help clinicians target these patients for interventions aiming to delay or stabilise the course of this disease.

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PubMed2003

[Burden experienced by informal caregivers assisting Alzheimer's patients in the REAL.FR study].

BACKGROUND: Most AD patients are cared for at home by informal caregivers. The effect of different kind of stressors on caregivers has been referred to as caregiver burden. OBJECTIVE: To determine (1) the level of burden of informal caregivers of Alzheimer's patients in a French national sample; (2) the factors associated with a high level of burden. METHODS: Cross-sectional study of informal caregivers of the demented elderly referred to a psychogeriatric, geriatric or neurological service. The principal caregivers of 531 patients with mild to moderate dementia attending an outpatient cognitive assessment clinic were interviewed via a structured questionnaire that focused upon caregiver-related characteristics such as whether they were living with the patients, their feelings of burden assessed by the Zarit Burden Interview and patients were examined at baseline to evaluate their cognitive, behavioral and functional limitation. RESULTS: Logistic regression analysis showed that patients' characteristics (MMSE, behavioral problems, nutritional problems), caregiver's characteristics (female gender, number of tasks involved in caregiving, cohabitation) and the provision of medical services were independently associated with a high level of burden. In this study increased caregiver burden was related independently to increased levels of patient behaviour disturbance and cognitive impairment. However, neither the illness duration nor the functional disabilities in activities of daily living affected the level of burden. This may have relevance to appropriate interventions for informal caregivers.

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PubMed2003

ESPEN guidelines for nutrition screening 2002.

AIM: To provide guidelines for nutrition risk screening applicable to different settings (community, hospital, elderly) based on published and validated evidence available until June 2002. NOTE: These guidelines deliberately make reference to the year 2002 in their title to indicate that this version is based on the evidence available until 2002 and that they need to be updated and adapted to current state of knowledge in the future. In order to reach this goal the Education and Clinical Practice Committee invites and welcomes all criticism and suggestions (button for mail to ECPC chairman).

Adult↗
PubMed2003

The REAL.FR research program on Alzheimer's disease and its management: methods and preliminary results.

We present here a descriptive analysis of data on inclusion of 579 Alzheimer Disease (AD) patients in the REAL.FR study. This is a French multicenter prospective study whose objectives are to study the natural history of AD and the modalities of its management. The study population consists of AD patients, living in the community at the time of enrolment and looked after by an informal caregiver. On inclusion, each patient underwent a full investigation which included gerontological and social evaluation. Patients will be seen every six months for at least four years. During follow-up, events which have occurred during the previous six months are noted (i.e. admissions to hospital or to an institution, use of new in-home help services ). On inclusion, the disease is still at a stage of cognitive impairment with little effect on basic autonomy. The general status of the patients is satisfactory but the risk of malnutrition and feeding difficulties is high and should be closely monitored. Particular attention should be paid to patients' nutritional status when they live alone or when caregiver burden is particularly heavy. Relatively few of the patients in our population were free from concomitant disorders. Eighty-three percent of patients were treated with acetylcholinesterase inhibitors. A history of cardiac disorders, comorbid disorders (>or= 3) or altered nutritional status was significantly correlated with the risk of not receiving treatment. The nature of the data collected will increase our understanding of different aspects of the disease: cognitive, behavioral, physical and social. The value of a multicenter approach lies in the fact that the modalities of organization of home support services and the availability of services from the private sector vary according to the local context. The results of our preliminary study are encouraging regarding the feasibility of patient follow-up. The satisfactory participation of patients and their families in the later evaluations which have already been carried out also seem promising for the continuation of follow-up.

Activities of Daily Living↗
PubMed2002

["The 5 words": a simple and sensitive test for the diagnosis of Alzheimer's disease].

OBJECTIVE: Alzheimer's disease (AD) is under-diagnosed in France. Today only an estimated 50% of patients are identified. Diagnosis of AD is particularly difficult because the amnesic syndrome, characteristic of the disease, is often confused with memory dysfunction that is frequent during the process of aging. The improvement in the diagnostic conditions of AD relies on the availability of a simple and reliable tool for screening memory disorders of organic origin. METHOD: The 5-word test studies the recall of a short list, which the physician ensures the patient has registered. Its construction permits the identification of patients exhibiting objective memory disorders. A validation study has been conducted in 86 patients suffering from AD and 126 persons complaining of functional memory disorders. RESULTS: The study has shown the sensitivity (91%) and specificity (87%) of the 5-word test in identifying patients with AD. CONCLUSION: This is a rapid (2 minutes) and simple test that is easy to use in medical practice for the screening of AD.

Age Factors↗