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J Touchon

Publications and source records attributed to J Touchon.

At least 37 records · Page 2Linked to original sources
PubMed2001

Classification criteria for mild cognitive impairment: a population-based validation study.

OBJECTIVE: To evaluate the predictive validity and temporal stability of diagnostic criteria for mild cognitive impairment (MCI). BACKGROUND: MCI has been proposed as a nosologic entity referring to elderly persons with subclinical cognitive deficits due to incipient dementia. Classification criteria, which have been derived from small, selected clinical groups, are currently disputed, and have not yet been assessed within the general population. METHODS: Subjects meeting current criteria for MCI and also age-associated cognitive decline (AACD-a similar concept that is assumed to be related to normal cognitive aging processes rather than incipient dementia) were identified within each of three waves of a longitudinal population study, which included a standardized neurologic examination. RESULTS: In the general population, the prevalence of MCI was estimated to be 3.2% and AACD 19.3%. MCI was a poor predictor of dementia within a 3-year period, with an 11.1% conversion rate. Subjects with MCI also constituted an unstable group, with almost all subjects changing category each year. Discriminant function analysis failed to isolate a homogeneous clinical group. Subjects classified as AACD, contrary to the theoretical assumptions underlying the disorder, represented a more stable group, with a 28.6% conversion rate to dementia over 3 years (relative risk = 21.2). CONCLUSION: MCI criteria perform poorly when applied to a representative population sample. The authors propose modifications to current diagnostic criteria to increase their capacity to detect incipient dementia.

Aged↗
PubMed2001

Disability and mild cognitive impairment: a longitudinal population-based study.

OBJECTIVE: To determine whether mild cognitive deficit is associated with parallel changes in ability to perform activities of daily living. BACKGROUND: While considerable research has been conducted on the effect of senile dementia and other neurodegenerative disorders on ability to perform everyday activities, little is known about the much larger group of elderly persons suffering from mild cognitive deficits. METHODS: Disability prevalence was estimated in 368 persons over the age of 65 years recruited from the general population via a general practitioner network. Subjects were followed over a 3-year period using computerized cognitive assessment and observations of everyday functioning. Standardized neurological assessment in the third year permitted the identification of subjects who have evolved towards dementia. RESULTS: An overall disability prevalence was found in the general population of 26.3%, with 30.8% in subjects with sub-clinical cognitive impairment. Longitudinal follow-up showed cognitive decline over time without dementia to be paralleled by changes in activity performance, with visuospatial deficits having the most marked effect on overall functioning. High intelligence quotient (IQ) and education are seen to reduce the degree of activity loss, but only when senile dementia is not present. CONCLUSIONS: Difficulties in the performance of everyday activities were found more frequently in non-demented subjects with mild cognitive deficits than in the general population. High pre-morbid levels of ability are seen to have a protective effect. A diagnosis of dementia should not therefore be required by persons with cognitive impairment applying for home help.

Activities of Daily Living↗
PubMed2001

[Sleep in fibromyalgia: review of clinical and polysomnographic data].

Fibromyalgia syndrome is a common chronic pain syndrome that is often associated with sleep disturbances characterized by subjective experience of non-restorative sleep. The complaints of sleep disturbances are correlated with polysomnographic features showing clear abnormalities in the continuity of sleep as well as in the sleep architecture. Sleep-recording abnormalities are characterized by a reduced sleep efficiency with increased number of awakenings, a reduced amount of slow wave sleep and an abnormal alpha wave intrusion in non rapid eye movement, termed alpha-delta sleep. These data were confirmed by spectral analysis of sleep showing an increased EEG power density in the higher frequency band and a reduced EEG power density in the lower frequency bands. Moreover, other microstructural aspects of sleep were modified with high frequency of arousals and alpha-K complex reported, both indicators of fragmented sleep. The fibromyalgia symptoms may relate to a non-restorative sleep disorder associated with the alpha-EEG sleep anomalies. However, alpha-EEG sleep anomaly is non-specific for fibrositis, also seen in normal controls during stage 4 sleep deprivation. Moreover, fibromyalgia patients may also experience primary sleep disorder such as sleep apnea or periodic leg movements. The etiology of this common condition is incompletely understood and the existence of a specific entity of fibromyalgia is still a matter of debate. However, several studies have found abnormal brain metabolism of substances such as serotonin implicated in sleep arousal and pain mechanisms and administration of tricyclic antidepressants and selective serotonin reuptake inhibitors may be useful in fibromyalgia. Pain, poor sleep quality and anxiety may contribute to the clinical picture. Several factors such as psychological, environmental, genetic factor, altered serotonin metabolism and altered sleep physiology are involved in the pathogenesis of fibromyalgia.

Adult↗
PubMed2001

Diagnostic value of quantitative EEG in Alzheimer's disease.

The aim of this study was to determine the performance of several spectral indices of the EEG (ratios between fast and slow EEG activities) as descriptors of the EEG changes occurring at the onset and during the evolution of Alzheimer's disease (AD). These indices were calculated from quantitative analysis of EEGs recorded in AD patients and from a matched non-demented group of control subjects. One advantage of such indices is to be independent of the absolute value of power spectral densities, which may vary from subject to subject, another being to take into account fast EEG activities. Conventional statistic tests and Receiver Operating Curves (ROC) analysis were performed upon these data to determine the accuracy of the power ratios to discriminate a) between controls and patients (i.e., to detect dementia) and b) between subgroups of patients defined according to the Global Deterioration Scale of Reisberg (GDS). The defined ratios provided a good classification of AD patients for all cerebral regions except the frontal areas, because of eye movement artefacts; the results confirm the increase in slow activities and the concomitant decrease in fast activities early in AD patients. Moreover, our results demonstrate that these indices are adapted tools to perform a good discrimination between demented and non-demented patients in routine clinical practice. We therefore propose the use of these EEG power ratios to discriminate between different stages of Alzheimer's disease, and to perform long-term monitoring of AD patients.

Aged↗
PubMed2001

Cognitive impairment in motor neuron disease with bulbar onset.

METHODS: Twenty-three patients with bulbar onset motor neuron disease/amyotrophic lateral sclerosis (MND/ALS) were clinically assessed. They subsequently underwent serial neuropsychological testing, event-related potentials (ERP) and SPECT studies. Cognitive impairment was defined by clinical evidence of dementia (DSM-IV and frontal evaluation) or by significant alteration indicated by neuropsychological testing (excluding patients with depression and major anxiety), or both. RESULTS: Eleven patients (48%) were found to be cognitively impaired. Abnormalities indicated fronto-temporal involvement, with memory impairment, alteration of judgement and reasoning, reduced speech, behavioural dyscontrol and alteration of daily living activities. This impairment correlated well with event-related potentials and SPECT studies. Event-related potentials were the most sensitive test as 100% of the impaired patients had abnormal ERP (p = 0.04). The cognitively impaired group differed from the other group mainly by gender ratio (male/female) with an important male predominance: 1.75 vs. 0.33. MND/ALS was also more severe when cognitive decline was present. CONCLUSION: This study adds further arguments for a cognitive impairment in MND/ALS. This also reinforces the hypothesis that there is continuum between MND/ALS and fronto-temporal lobe dementia.

Activities of Daily Living↗
PubMed2001

Discrepancies between apolipoprotein E phenotyping and genotyping in the elderly.

We estimated the frequencies of phenotype (isoelectric focusing; IEF) vs. genotype (PCR/Hhal) discordance in a sample of an aged population (> 65 years). Both phenotype and genotype techniques have been used in the study of apolipoprotein E (apoE) polymorphism in 125 elderly subjects. The discordance between phenotype and genotype was unresolved in 11 (8.8%) of the 125 unrelated subjects studied. We observed a significant association between the presence of the E4 allele and both Alzheimer's disease (chi2 = 13, p < 0.001) and increased cholesterol concentration (Mann Whitney, p < 0.03). These relationships were not affected by the techniques used. Our results indicate that transcriptional modulation and post-transductional modifications in normal ageing and in aged-related diseases may explain in part discrepancies between gene analysis and protein characterisation.

Aged↗
PubMed2000

[Non-steroidal anti-inflammatory drugs with selectivity for cyclooxygenase-2 in Alzheimer's disease. Rationale and perspectives].

POSSIBLE INFLAMMATORY MECHANISMS: Alzheimer's disease (AD) is a degenerative disease of the brain including possibly inflammatory mechanisms, as illustrated by the presence of activated microglial cells in the periphery of senile plaques and neurofibrillary tangles and the subsequent release of proinflammatory mediators with neurotoxic potency. RATIONALE FOR NSAID USE: Although not firmly demonstrated, the rationale for the prescription of non steroidal anti-inflammatory drugs (NSAIDS) as neuroprotective agents in AD lies on epidemiological data having shown a reduced risk of developing AD in patients on long-term therapy with NSAIDs (non selective cyclo-oxygenase [COX] inhibitors). RATIONALE FOR THE USE OF SELECTIVE COX-2 INHIBITORS: The rationale for the prescription of selective COX-2 inhibitors as neuroprotective drugs in AD lies on: Epidemiological data having shown a reduced risk of developing AD in patients treated with anti-inflammatory doses of classical NSAIDs (inhibition of COX-1 and COX-2) but not with antithrombotic doses of aspirin (selective inhibition of COX-1), Cellular experiments, Demonstration of a better gastro-intestinal (GI) safety profile with selective COX-2 inhibitors than with classical NSAIDs in short-term studies, allowing a possible long-term use in AD. BEFORE PRESCRIBING: COX-2 may have an ambivalent functionality in the brain since the basal production of prostaglandins through COX-2 may participate in neuronal homeostasis whereas the expression of COX-2 is associated with brain development. Classical NSAIDs are ineffective in reducing the formation of senile plaque and neurofibrillary tangles in AD, which is consistent with an ability to reduce inflammation associated with activation of microglia but illustrates their failure to suppress the degenerative process. Prophylactic use of selective COX-2 NSAIDs can be considered on the basis of their good GI safety after 6 months of marketing in United States but need to be confirmed for a longer time. CURRENT TRIALS: Clinical studies focusing on both the prevention and the slowing down of early AD are under way with two recently launched selective COX-2 inhibitors, celecoxib and rofecoxib.

Adult↗
PubMed1999

Tau and apo E in CSF: potential aid for discriminating Alzheimer's disease from other dementias.

To evaluate the usefulness of tau proteins as biological markers in the diagnosis of dementia of the Alzheimer type (DAT), we analyzed the concentration of tau proteins in 253 cerebrospinal fluid (CSF) samples from patients with or without neurological disorders. Our study showed a significant increase of the mean CSF tau concentration in DAT patients compared with that from non-DAT patients. Interestingly, a significative decrease of CSF tau in patients with frontotemporal dementia was found. We also observed a positive correlation between the CSF-tau concentration and the number of apoepsilon4 alleles. The CSF apolipoprotein E concentration was evaluated and revealed no variation between the groups, although we observed a significant correlation between CSF tau and apolipoprotein E in DAT patients.

Age Factors↗
PubMed1999

Cognitive decline in ageing: are AAMI and AACD distinct entities?

BACKGROUND: Two sets of research diagnostic criteria, age-associated memory impairment (AAMI) and ageing-associated cognitive decline (AACD), are widely used to describe mild cognitive decline in ageing. However, the extent to which the nosological entities they represent are similar or distinct is unclear. METHODS: A sample of 111 participants without dementia but with informant evidence of cognitive decline were drawn from the EUGERIA Study of Cognitive Ageing, a population-based study in southern France. These participants were classified as either normal or with AAMI according to the criteria of Crook et al. (1986), then reclassified as normal or with AACD according to criteria recommended by Levy et al. (1994). Neuropsychological test scores were then compared in these two pairs of groups. RESULTS: Particpants were classified as either normal (N=74) or with AAMI (N=37), then reclassified as normal (N=72) or with AACD (N=39). Only 20 (54%) of participants with AAMI simultaneously met criteria for AACD, and those with AACD showed more extensive cognitive impairment than those with AAMI. CONCLUSIONS: Although there is a large overlap between AAMI and AACD, these findings suggest that AAMI and AACD refer to distinct clinical entities, the latter delineating a more severe state of impairment. This may be largely because AAMI is defined as impairment with reference to young normals, whereas AACD refers to impairment with respect to normal contemporaries.

Aged↗
PubMed1999

Prodromal cognitive disorder in Alzheimer's disease.

INTRODUCTION: To trace the prodromal evolution of Alzheimer's disease using a comprehensive computerized cognitive battery and an evaluation of performance of everyday activities. MATERIALS AND METHODS: A general population cohort of 397 normal elderly persons hypothesized to have an increased risk of developing Alzheimer's disease was examined over a 3-year period. Twenty-two subjects developed AD in the third year and their performance was compared retrospectively with 150 subjects who had remained free of senile dementia and other psychiatric disorders throughout the period of the study. RESULTS: Adjusting for effects of age, education and incident illness, significant differences were found between the two groups on a wide range of tests 2 years before diagnosis. For half of these tests the decline was largely limited to persons with low levels of education. Education effects closer to the time of diagnosis were limited to a small number of verbal tasks. CONCLUSION: Patterns of cognitive impairment may be detected in cases of AD 2 years before formal clinical diagnosis, although high education level prolongs competence, principally on verbal tasks. The results suggest that a number of brief cognitive tests may have face validity and high discriminability independent of education level in the evaluation of cognitive complaints in early stage AD in the general practice setting.

Aged↗
PubMed1999

Quality-of-life assessment in the old using the WHOQOL 100: differences between patients with senile dementia and patients with cancer.

INTRODUCTION: The measurement of quality of life is an increasingly important issue, particularly in regard to treatment of severe and chronic diseases. The aim of this pilot study was to assess potentially divergent profiles of quality of life in persons with two different pathologies: moderate dementia and cancer. METHOD: This pilot study was carried out in the neurology and cancer services of the medical school in Montpellier, France (Hôpital Gui de Chaulliac and CRLC Val d'Aurelle). The cumulative self-reporting test WHOQOL 100 (World Health Organization Quality of Life with 100 questions) was administered in 57 patients with either moderate senile dementia (27 cases with a Mini-Mental State Examination score >15; mean age of 73) or cancer (30 cases, mainly women with breast cancer; mean age of 53). The stability of responses was tested in a 2-week period. RESULTS: Results of the study showed clear and significant differences between the two groups in the domains of mobility and psychology. Further, eight questions and six facets with a significant difference in responses were found. Responses seemed more stable in the domains of autonomy, social relationship, and religion for the cancer group, and in autonomy and psychology for the dementia group. The age difference may be an important factor in the different quality of life measured but did not significantly influence responses to the test questions. CONCLUSION: The WHOQOL 100 seems a powerful instrument to assess quality of life in diseases such as cancer and moderate dementia. In this study, interesting differences in responses to the test questions between the two pathologic conditions were identified. Items that were unreliable on retesting are singled out. These results will be applied and reevaluated in the development of future, illness-specific and shorter versions of the WHOQOL 100.

Aged↗
PubMed1999

Depressive illness, depressive symptomatology and regional cerebral blood flow in elderly people with sub-clinical cognitive impairment.

BACKGROUND: Depressive illness in dementia is often assumed to be a unitary clinical phenomenon. AIM: To describe changes in patterns of depressive symptomatology with time, and associated changes in cerebral blood flow to the frontal and temporal regions. METHOD AND RESULTS: 397 elderly people with sub-clinical cognitive dysfunction were observed over 3 years. Sixteen percent of them developed dementia during the study The prevalence of depressive symptomatology was higher in this group than in the general population, especially in women, who also had higher recovery rates. A changing profile of depressive symptoms was found in depressed elderly people progressing to dementia, with fewer affective symptoms and increases in agitation and motor slowing. These changes were paralleled by greater reductions in left temporal regional cerebral blood flow than in non-depressed subjects with Alzheimer's disease. CONCLUSION: In dementia, there may be two separate and interacting depressive syndromes whose differentiation may be clinically important.

Aged↗
PubMed1999

The effects of wine and tobacco consumption on cognitive performance in the elderly: a longitudinal study of relative risk.

BACKGROUND: Evidence relating to the potentially protective effect of smoking and alcohol consumption in relation to senescent cognitive decline and Alzheimer's disease is inconclusive. METHODS: The relationship between wine and tobacco consumption and cognitive change was assessed within a longitudinal study of normal elderly people showing recent instability in cognitive functioning using an extensive battery of cognitive tests. RESULTS: While moderate wine consumption was found to be associated with a fourfold diminishing of the risk of Alzheimer's disease (OR = 0.26), as found in other studies, this effect was found to disappear when institutionalization was taken into account. Wine consumption was associated with an increased risk of decline over time in attention and in secondary memory. No protective effect for Alzheimer's disease was found for smoking, although smoking was associated with a decreased risk for decline over time in attentional and visuospatial functioning. No clear combined effect of smoking and drinking was found, even though smoking was found to increase the risk of decline in language performance when adjusted on wine consumption. CONCLUSIONS: There is no evidence to suggest that wine and tobacco consumption may protect against Alzheimer's disease.

Aged↗
PubMed1998

[Hypersomnia. Narcolepsy-cataplexy (Gélineau syndrome)].

SIGNS AND SYMPTOMS: Narcolepsy is the most prevalent of the primary disorders of vigilance. It is relatively easy to identify in presence of clearcut cataplexy and other REM-sleep related symptoms, i.e. sleep paralysis and hypnagogic hallucinations. Otherwise, one must rely on demonstration of sleep onsets in REM during night and daytime polygraphy, and on the very strong association with the HLA gene DQB1*0602. TREATMENT: With the advent of modafinil, treatment of narcolepsy has been substantially modified. New strategies are an improvement over amphetamines both in terms of side effects and long-term outcome. Most cataplectic attacks can be controlled by tricyclics or other antidepressants. PATHOGENESIS: Major advances in pathophysiology and etiology have been obtained through an animal model of the disease, canine narcolepsy. Pharmacological studies point to the importance of alpha-1 adrenergic mechanisms in cataplexy, while dopaminergic systems seem more involved in generating sleepiness. As concerns genetics of this autosomal recessive disease, there is an equivalent of the human HLA association in the form of an immunoglobulin gene (mu-switch) linkage. Narcolepsy research is now looking for other genes, for which familial cases may give clues.

Animals↗
PubMed1998

[Mental-behavioral disorders in Alzheimer's disease].

Behavioural and psychological disorders are often observed in Alzheimer's disease. Some are common, such as symptoms of depression, apathy, aggressivity, agitation, psychotic disturbances, disorders of sleep rhythm, etc. Many factors contribute to the aetiology of these disorders, mainly cerebral lesions, environmental changes, somatic illnesses, iatrogenic factors and psychological reaction mechanisms. Management must take each into account. Treatment comprises medication (symptomatic treatment of the various disorders, cholinergic treatment) and other means (adaptation of the inhabitation, informing family and friends, psychotherapy, etc.).

Affective Symptoms↗