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Bruno Vellas

Publications and source records attributed to Bruno Vellas.

At least 37 records · Page 2Linked to original sources
PubMed2004

Muscle strength in obese elderly women: effect of recreational physical activity in a cross-sectional study.

BACKGROUND: Muscle strength (MS) may be impaired in obese persons, and this impairment may be a consequence of both obesity and low physical fitness. OBJECTIVE: We investigated whether MS differed between obese [body mass index (BMI; in kg/m2 > 29], normal-weight (BMI = 24-29), and lean (BMI < 24) elderly subjects and compared the MS of sedentary and active subjects according to their BMI group. DESIGN: The study included 215 obese [ (+/- SD) age: 80.0 +/- 3.5 y; BMI: 31.9 +/- 2.6], 630 normal-weight (age: 80.2 +/- 3.7 y; BMI: 26.3 +/- 1.4), and 598 lean (age: 80.7 +/- 3.5 y; BMI: 21.6 +/- 1.8) women with good functional ability. A cross-sectional design was used. Anthropometric measures (weight, height); measures of appendicular skeletal muscle mass (by dual-energy X-ray absorptiometry), isometric knee and elbow extension (by statergometer), and isometric handgrip strength (by dynamometer); and data on health status and self-reported recreational physical activity (RPA: walking, gymnastics, cycling, swimming, gardening) were collected. RESULTS: Absolute (unadjusted) MS was higher in obese than in lean women (P < 0.01), except for handgrip strength (P > 0.05). When adjusted for age, height, RPA, pain, depression, and appendicular skeletal muscle mass, MS did not differ significantly between obese, normal-weight, and lean subjects, except for knee extension (significant interaction effect with RPA; P = 0.01). With increasing BMI, lower limb strength did not change in the sedentary women but increased in active (> or = 1 h/wk in > or = 1 RPA for > or = 1 mo) women. All adjusted MS measures in active participants were significantly higher (P < 0.001) than those in their sedentary peers. CONCLUSION: The adjusted MS of elderly women is not associated with obesity but is higher in active subjects than in sedentary ones, especially in the lower limbs of obese subjects.

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PubMed2004

Minimum data set for nutritional intervention studies in elderly people.

Malnutrition, considered for the purpose of the present data set as undernutrition, is a major risk factor of mortality in elderly people. Such protein-energy malnutrition should be detected as soon as possible. Once established, this malnutrition state must be corrected by appropriate diet, supplementation, artificial nutrition, or therapeutic treatment. If carried out well, these interventions should reduce the risk of mortality and, for some diseases such as degenerative diseases, may postpone morbidity and dependence. The efficiency of nutritional interventions has already been evaluated by different means including the measurement of anthropometric and laboratory parameters. However, in the absence of a consensus on the use of these parameters, comparison between studies and even effectiveness of the proposed treatment are frequently unconvincing. The relevance of the most common markers used in epidemiologic studies on malnutrition and nutritional interventions in elderly persons was studied for establishing a minimum data set. The aim of this task force was to provide investigators and operators in the field of clinical nutrition with clear and expert validated clinical outcomes allowing them to design and set up conclusive trials.

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PubMed2004

Improvement of weight and fat-free mass with oral nutritional supplementation in patients with Alzheimer's disease at risk of malnutrition: a prospective randomized study.

OBJECTIVES: To study the effects of oral nutritional supplements (OS) on body weight, body composition, nutritional status, and cognition in elderly patients with Alzheimer's disease (AD). DESIGN: Prospective, randomized, controlled study. SETTING: Geriatric wards and day care centers in the Toulouse area, France. PARTICIPANTS: Ninety-one subjects with AD aged 65 and older at risk of undernutrition as evaluated using the Mini Nutritional Assessment. INTERVENTION: After randomization, 46 patients (intervention group) received 3-month OS. The other 45 patients (control group) received usual care. MEASUREMENTS: Weight, body composition (evaluated using dual-energy x-ray absorptiometry), cognitive function, activities of daily living, eating behavior, and dietary intakes were evaluated at the beginning of the study and at 3 months and 6 months. Supplement compliance was recorded each day. RESULTS: Between baseline and 3 months, energy and protein intakes significantly improved in the intervention group, resulting in a significant increase in weight and fat-free mass, but no significant changes were found for dependence, cognitive function, or biological markers. The nutritional benefit was maintained in the intervention group after discontinuation of OS at 3 months. CONCLUSION: Three-month daily OS significantly improves body weight. It is practicable and effective, and the patients accepted it well. The improvement that was observed even in the control group showed that caregiver education is an important factor in maintaining the nutritional status of patients with AD. Moreover, regular courses of OS may help to maintain the increase in fat-free mass and improve the nutritional status of these patients.

Adipose Tissue↗
PubMed2004

What are the treatment options for patients with severe Alzheimer's disease?

By some estimates moderate-to-severe Alzheimer's disease accounts for 50% of all patients with Alzheimer's disease. However, there are numerous issues that remain to be resolved in the management of patients with more advanced Alzheimer's disease. The first prospective, randomised, controlled trial of the cholinesterase inhibitor donepezil in more advanced Alzheimer's disease has reported quite encouraging results, with further studies being undertaken. Post-hoc analyses of rivastigmine and galantamine in patients with more advanced Alzheimer's disease have supported the hypothesis that acetylcholinesterase inhibitors are likely be efficacious in this subgroup. Memantine, a glutamate NMDA receptor antagonist, is newly licensed in Europe for the treatment of more advanced Alzheimer's disease and will provide the first non-cholinesterase inhibitor option for the treatment of Alzheimer's disease. The combination of donepezil and memantine has been shown to have superior efficacy than donepezil alone in this severe Alzheimer's disease subgroup, potentially supporting a role for dual treatment in more advanced Alzheimer's disease. Further studies of all aspects of more advanced Alzheimer's disease are clearly needed. The problems of translating clinical trial results to routine clinical practice are even more complex and challenging in this patient group, with the true impact of any one given treatment ranging over a spectrum of clinical domains from improved cognition to reduced caregiver burden. Increased attentiveness by clinicians to treatment response across this multidisciplinary spectrum in more advanced Alzheimer's disease is warranted.

Alzheimer Disease↗
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.

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PubMed2003

Body composition in French women 75+ years of age: the EPIDOS study.

BACKGROUND: There are presently no published data on age-related changes in body composition in French individuals older than 65 or 80 years. This paper presents a cross-sectional study of 7518 community-residing French women older than 75 years. METHODS: We examined age differences changes in body composition and anthropometry between age groups (76-80, 81-85, and 86-95 years of age). Whole body composition was estimated using a dual energy X-ray absorptiometry (DXA) scanner. Measurements of appendicular skeletal muscle (ASM) mass and sarcopenia were performed for a subsample of 1321 women. RESULTS: Significant age differences exist in total fat mass and total bone mineral content in elderly women between 76 and 95 years of age. There was also a significant decreased in fat free soft tissue mass from 76 to 85. The decline in fat free mass may be reduced over 85 years of age. The prevalence of low muscle mass, or sarcopenia, increased with age from 8.9 in 76-80 to 10.9% in 86-95 age group, but the difference was not statistically significant. CONCLUSIONS: Interventional programs developed to prevent or reduce sarcopenia would have a better influence on population under 85 years, i.e. when the decline in ASM mass is the most severe. Others longitudinal studies could be performed to confirm our results.

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PubMed2003

Comparison of bone mineral density and body composition measurements in women obtained from two DXA instruments.

Information is lacking regarding the comparison of bone mineral and body composition measurements obtained from the different dual energy X-ray absorptiometry (DXA) systems. The purpose of this study is to compare body composition and whole body bone mineral density (BMD) measurements from the hologic QDR-4500 W (DXA H) and the lunar (DXA L) systems. Seven women older than 40 years of age, were scanned on the same day by using DXA H and DXA L by the same observer. Measured total fat mass, percentage fat, whole body fat free soft tissue mass and BMD were similar between machines, but body mass was significantly higher with DXA L than with DXA H (P=0.0156). This was due to a higher bone mineral content obtained with DXA L. Agreement between the two DXA systems was quantified by using the Bland and Altman method. For each variable, all pairs of measurements were within the 95% confidence limits. These results suggested that we could use the two measurement methods interchangeably. However, due to the bone mineral inter-machine differences, comparisons of DXA measurements from different machines should be interpreted with caution.

Absorptiometry, Photon↗
PubMed2003

Immunologic and inflammatory mediators and cognitive decline in Alzheimer's disease.

Local up-regulation of immune mediators is implicated in the development of AD; however, the systemic cell-mediated immune response in patients with AD may be impaired. Progression of AD from moderate to severe stages is accompanied by a progressive decline in cognitive function, independence, and behavioral and motor impairments and by the occurrence of recurrent infections, such as bronchitis and pneumonia. Several factors, including malnutrition, may be implicated in the reduced ability to mount an adequate immune response against invading pathogens in advanced stages of AD. The immune system has an important role in the development, progression, and potential treatment of AD and is involved in determining the subsequent sequelae and morbidity outcomes in patients with advanced-stage AD. A better understanding of the immune mediators that are involved in the local and systemic immune response in AD may assist in mediating the development of AD, halting its progression, and treating patients with anti-inflammatory drugs and immunization strategies.

Aging↗
PubMed2003

Efficacy of donepezil on maintenance of activities of daily living in patients with moderate to severe Alzheimer's disease and the effect on caregiver burden.

OBJECTIVES: This study investigated the efficacy of donepezil treatment on activities of daily living (ADLs) and social functioning in patients with moderate to severe Alzheimer's disease (AD) and the possible benefits of this treatment on caregiving time and stress levels. DESIGN: Randomized, double-blind, placebo-controlled, multinational study. SETTING: Patients resided in the community or in assisted living facilities who did not require skilled 24-hour nursing care. PARTICIPANTS: Two hundred ninety patients with moderate to severe AD (baseline standardized Mini-Mental State Examination score of 5-17). INTERVENTION: Donepezil (5 mg/d for 4 weeks and 10 mg/d per clinician's judgment thereafter) or placebo for 24 weeks. MEASUREMENTS: ADLs were assessed using the Disability Assessment for Dementia (DAD), the modified instrumental activities of daily living (IADL) scale (IADL+), and the modified Physical Self Maintenance Scale (PSMS+). Caregiver time spent assisting patients with basic and instrumental ADLs was recorded as part of the IADL+ and PSMS+ scales. Patients' social behavior was evaluated through the use of a caregiver diary that captured observations of patients' motivation, interactions, and engagement. Caregivers were evaluated for their levels of caregiver stress with a modified, multiple-item Caregiver Stress Scale (CSS). For each outcome measure, the mean change from baseline at Week 24 using a last observation carried forward (LOCF) analysis was calculated. RESULTS: IADL+ and PSMS+ mean change from baseline scores for donepezil-treated patients showed a slower decline during the study than placebo-treated patients (Week 24 LOCF mean treatment differences: IADL+ = 6.83, P <.0001; PSMS+ = 1.32, P =.0015). Significant differences between the groups in favor of donepezil were observed on the DAD for instrumental and basic ADLs and on the three components required for the completion of each ADL: initiation, planning and organization, and effective performance. At baseline, caregivers of patients treated with donepezil (n = 141) did not differ significantly from caregivers of patients treated with placebo (n = 146) with respect to demographics or mean total scores on the CSS. At Week 24 LOCF, the overall distribution of caregiver ratings on each of the three caregiver diary items favored donepezil-treated patients over placebo-treated patients (P <.005). At Week 24 LOCF, mean change from baseline scores for CSS total and individual domain scores (all domains except caregiving competence, personal gain, and management of distress) were better for caregivers of donepezil-treated patients than for those of placebo-treated patients (CSS total, mean treatment difference = 1.82). Caregivers of donepezil-treated patients reported spending less time assisting with ADLs than caregivers of placebo-treated patients (mean difference = 52.4 min/d). CONCLUSION: Donepezil demonstrated a significantly slower decline than placebo in instrumental and basic ADLs in these patients with moderate to severe AD. The ADL benefits in AD patients treated with donepezil were associated with less caregiving time and lower levels of caregiver stress.

Activities of Daily Living↗
PubMed2003

Sarcopenia, calf circumference, and physical function of elderly women: a cross-sectional study.

OBJECTIVES: To determine whether calf circumference (CC), related to appendicular skeletal muscle mass, can be used as a measure of sarcopenia and is related to physical function. DESIGN: Retrospective analysis of data from 1992 to 1994 of the European Patient Information and Documentation Systems Study. SETTING: Community setting in France. PARTICIPANTS: One thousand four hundred fifty-eight French women aged 70 and older without previous history of hip fracture were recruited from the electoral lists. MEASUREMENTS: Muscular mass was assessed using dual-energy x-ray absorptiometry (DEXA). CC was measured using a tape measure. Anthropometric measurements (height; weight; and waist, hip, and calf circumference), strength markers (grip strength), and self-reported physical function were also determined. Sarcopenia was defined (using DEXA) as appendicular skeletal muscle mass (weight (kg)/height (m2)) less than two standard deviations below the mean of a young female reference group. RESULTS: The prevalence of sarcopenia was 9.5%. CC was correlated with appendicular skeletal muscle mass (r = 0.63). CC under 31 cm was the best clinical indicator of sarcopenia (sensitivity = 44.3%, specificity = 91.4%). CC under 31 cm was associated with disability and self-reported physical function but not sarcopenia (defined using DEXA), independent of age, comorbidity, obesity, income, health behavior, and visual impairment. CONCLUSION: CC cannot be used to predict sarcopenia defined using DEXA but provides valuable information on muscle-related disability and physical function.

Absorptiometry, Photon↗
PubMed2003

Association of Alzheimer's disease onset with ginkgo biloba and other symptomatic cognitive treatments in a population of women aged 75 years and older from the EPIDOS study.

BACKGROUND: Peripheral C4A treatment (cerebral and peripheral vasotherapeutics) and especially Ginkgo biloba extracts are prescribed for a number of symptoms, particularly memory impairment, in elderly patients. It is postulated that because of its pharmacological actions, this treatment could prevent the decline of cognitive function, but no studies have been published to date to test its efficacy in prevention of Alzheimer's disease. The potential association between use of C4A treatments, in particular EGb 761 (standardized Ginkgo biloba extracts), and dementia of the Alzheimer type was investigated. METHODS: A case-control study was nested in a cohort of 1462 community-dwelling elderly women aged over 75 years. Sixty-nine women with Alzheimer-type dementia were compared with 345 paired women whose cognitive function remained normal. This study involved women whose cognitive function was evaluated at baseline by use of Pfeiffer's test and whose medication history was taken. The onset of cognitive impairment was investigated over a 7-year follow-up period. In order to study the factors associated with the onset of dementia, the data concerning women with a score of > or = 8 on Pfeiffer's test at inclusion, indicating normal cognitive function, were analyzed. RESULTS: A multivariate analysis including potential confounding factors showed that fewer women who developed Alzheimer's dementia had been prescribed C4A treatment (including EGb 761) for at least 2 years (odds ratio = 0.31, 95% confidence interval = 0.12-0.82, p =.018). Figures for EGb 761 alone were similar but did not reach statistical significance (odds ratio = 0.38, 95% confidence interval = 0.08-1.76, p =.22). CONCLUSION: These results suggest that C4A treatment may reduce the risk of developing Alzheimer's dementia in elderly women. The potential preventive effect of C4A treatments, including EGb 761, requires further examination. To establish a causal relationship, these findings have to be confirmed with prospective studies.

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PubMed2003

Diabetes is associated with subclinical functional limitation in nondisabled older individuals: the Health, Aging, and Body Composition study.

OBJECTIVE: The aim of this study was to examine the role of comorbid conditions and body composition in the association between diabetes and subclinical functional limitation, an indication of early functional decline, in well-functioning older individuals. RESEARCH DESIGN AND METHODS: This was a cross-sectional analysis of 3,075 well-functioning black and white men and women aged 70-79 years, enrolled in the Health, Aging, and Body Composition study. Diabetes was defined by self-report and/or hypoglycemic medication use or fasting glucose >/=126 mg/dl. Subclinical functional limitation was defined using self-report of capacity and objective performance measures. Comorbid conditions were identified by self-reported diagnoses, medication use, and clinical measures. Body composition measures included anthropometry and total fat (dual X-ray absorptiometry). RESULTS: Of 2,926 participants, 1,252 (42.8%) had subclinical functional limitation at baseline. Among 2,370 individuals without diabetes, 40% had subclinical functional limitation, whereas the prevalence was 53% among the 556 diabetic participants with an age/sex/race-adjusted odds ratio (OR) 1.70 (95% CI 1.40-2.06). This association remained significant when adjusted for body composition measures (OR 1.54 [1.26-1.88]), diabetes-related comorbidities, and other potential confounders (OR 1.40 [1.14-1.73]). In the fully adjusted model, consideration of HbA(1c) (< or >/=7%) and diabetes duration showed that poor glycemic control in diabetic individuals explained the association with subclinical functional limitation. CONCLUSIONS: In a well-functioning older population, diabetes is associated with early indicators of functional decline, even after accounting for body composition and diabetes-related comorbidities. Poor glycemic control contributes to this relationship. Whether improvement in glycemic control in older people with diabetes would change this association should be tested.

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PubMed2003

Mild cognitive impairment: a nosological entity?

Mild cognitive impairment is not an established diagnosis but a concept for which different criteria have been proposed and modified over time. Mild cognitive impairment refers to the transitional zone between normal ageing and dementia. The mild cognitive impairment stage may be one of the optimum stages at which to intervene with preventive therapies. The heterogeneity of the term has been recognized. Multiple sources of heterogeneity have been described for mild cognitive impairment, including biological factors, clinical symptoms and clinical course. It is still not possible to consider mild cognitive impairment as an explicit predictor of Alzheimer's disease with the current criteria. The heterogeneity within mild cognitive impairment has been noted, and a classification has been proposed: amnestic or single memory mild cognitive impairment, multiple domains mild cognitive impairment, and single non-memory mild cognitive impairment. Future research should be focussed on redefining the criteria of the mild cognitive impairment entity. This could enable the better development of appropriate therapeutic interventions.

Alzheimer Disease↗
PubMed2003

[Behavioral disorders in dementia: intervention study in a long-term care unit].

UNLABELLED: Behavioral disorders are frequent in the course of dementia. They often result in inappropriate drug prescription, and an increased risk of morbidity and mortality. They also have a major negative impact on the caregiver's burden. We present an intervention study on the carers of demented patients in a long-term care unit. METHODS: We studied 26 patients with dementia (mean age -/+ 86.6 +/- 6.4 years) hospitalized in a long-term care unit at the Toulouse university hospital. Frequency and related distress of behavioral disturbances were assessed using the Neuropsychiatric Inventory (NPI). After a first patient evaluation, the staff of the unit underwent a specific program of education and training to cope with these behavioral problems. This was followed by a second comparative evaluation of the patients. RESULTS: We observed a significant decrease of frequency, severity and related distress of behavioral symptoms. Significant changes in severity were found in depression, delusions, hallucinations, apathy and irritability. Distress related to agitation, depression and irritability was significantly reduced. CONCLUSION: Our study shows a positive effect of an educative intervention on patient is behavior and caregiver distress. Similar actions reported in the literature note a variability in the response depending on the type of population and nature of the intervention. Due to the lack of a control group, we are unable to assess the specificity of the intervention programme. However, the magnitude of the observed changes support its general methodology. The use of quantitative tools such as the NPI is very helpful to improve the understanding of behavioral problems in demented people and to assess their management.

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PubMed2002

Predictive factors of acute hospitalization in 134 patients with Alzheimer's disease: a one year prospective study.

OBJECTIVE: To evaluate the frequency of and determine predictive factors for acute hospitalization in a prospective study of patients with Alzheimer's disease (AD). DESIGN: A one year prospective study. PARTICIPANTS: 134 patients recruited from the memory clinic in Toulouse University Hospital, with AD diagnosed using the NINCDS-ADRDA criteria. MEASURES: A comprehensive geriatric and neuropsychological assessment was conducted 6 monthly. RESULTS: Among the 134 patients included in this study, at one year follow up, 32 patients had at least one acute hospitalization. Patient-related variables predictive of acute hospitalization in the univariate analysis were: level of education, ADL-bathing, ADL-toileting, ADL-feeding, total ADL score, IADL A scale (daily upkeep), history of falls, and level of behavioural disorder as measured by the Cohen scale. In the multivariate regression model, two variables were associated with acute hospitalization: dependency for ADL-bathing [Odds Ratio (OR) = 5.65, 95% Confidence Intervals (CI): 2.3-14.4] and low level of education. CONCLUSION: The results of this study demonstrate that acute hospitalization is frequent in AD patients resulting in considerable cost implications. Interventions that support patients and their cares to manage their loss of ADL may be a practical approach to reducing the need for acute hospital admissions.

Activities of Daily Living↗
PubMed2002

Cognitive function and caregiver burden: predictive factors for eating behaviour disorders in Alzheimer's disease.

BACKGROUND: Patients with Alzheimer's disease (AD) commonly develop aversive feeding behaviours. These behaviours lead to weight loss and frequently to physicians using tube feeding. Little is known about factors correlated with feeding difficulties during AD. OBJECTIVE: To investigate predictors of aversive feeding behaviours (AFBs) which occurred during a one-year interval among AD patients living at home with a caregiver. METHOD: One-year study initiated in January 1998 with 224 AD patients and their caregivers. MAIN OUTCOME MEASURES: all patients underwent a nutritional, psychologic and functional evaluation at baseline and one year later. Feeding difficulties were assessed using the Feeding Dependency Scale and the Aversive Feeding Behaviour Inventory. The Burden Interview was also done to assess the material and emotional burden. RESULTS: Initial feeding difficulties were significantly associated with the age of the caregiver, the severity of the disease and the initial patient's autonomy and psychological functioning (mood and behaviour disorders). AD patients, who lived with a more affected caregiver at baseline, developed feeding difficulties and AFBs during the follow-up. Logistic regression analysis showed a positive association between AFBs worsening and the initial caregiver's burden after controlling for confounding factors. On the other hand, memory impairment was inversely associated with AFBs. CONCLUSIONS: Both cognitive impairment and family stress can help in predicting which AD patients living at home will develop AFBs. Nutritional information and support to families are probably the best strategies to prevent AFBs during AD and to improve consequently the patient's and caregiver's quality of life.

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