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Biomedical subjects

J Touchon

Publications and source records attributed to J Touchon.

At least 55 records · Page 3Linked to original sources
PubMed1998

Progressive disability in senile dementia is accelerated in the presence of depression.

OBJECTIVES: To assess the extent to which loss of ability to perform everyday activities in early stage senile dementia is worsened by the presence of depressive illness. METHODS: To evolution of disabilities is measured by an activity scale permitting observation of small changes in everyday performance in a cohort of 397 elderly persons with subclinical cognitive deficit. Over the 3 years of the study, 11% of the cohort developed dementia without depression and 5% dementia with depression. RESULTS: Progressive disablement was found to be greater in persons with senile dementia as compared to normal subjects. Depression alone had no significant effect over the time period. Persons with both senile dementia and depression had significantly higher rates of disability at 3 years than persons with senile dementia alone. Significantly greater decrements across the observation period were observed in dressing, washing, use of telephone and continence in the senile dementia-depression group only. CONCLUSION: Depression does not in itself engender significant disability, but interacts with senile dementia to accelerate loss of functioning. Effective treatment of depressive illness in senile dementia may have significant impact on the prevalence and severity of disability.

Activities of Daily Living↗
PubMed1998

[Early diagnosis of Alzheimer disease].

On of the major challenges for public health in developed countries for the 21st century is that of aging, and in particular Alzheimer's disease. Progress has been made in the development of symptomatic treatment and prevention and early diagnosis of Alzheimer's disease is becoming mandatory. In the present state of our knowledge, no marker for early diagnosis has been described. However, the combined use of clinical observations (behavioral and neuropsychological features) and complementary information (brain morphology and functional imaging, biological data, neurophysiology explorations) could be helpful for early diagnosis of Alzheimer's disease well before the onset of dementia.

Aged↗
PubMed1998

[Consensus statement of an interdisciplinary group of French experts on modalities of diagnosis and medical treatment of Alzheimer's disease at a treatable stage].

A group of French expert met on the 7th and 8th of February 1998 in order to establish a consensus attitude for Alzheimer's disease diagnosis and treatment. Members were drawn from primary care, geriatrics, neurology and psychiatry. They used the consensus statement of the American Association for Geriatrics, the Alzheimer's Association and the American Geriatrics Society published in JAMA, in October 1997 as a source of data for further consideration. Alzheimer's disease in the most common etiology of dementia. Main clinical features are cognitive impairment and psycho-behavioral disorders. Diagnosis must be one of inclusion and not exclusion. It is based on interviews of informants and family members and office-based clinical assessment. After a physical examination, cognitive function must be evaluated using the Mini-Mental State Examination. A laboratory evaluation should include a complete blood cell count, blood chemistry and determination of thyroid-stimulating hormone. In addition, noncontrast computed tomography head scans are adequate in most cases. Available pharmacologic treatments are not curative but are given to improve quality of life and enhance cognition and behavior. Two cholinesterases inhibitors, tacrine and donepezil, are the only agents officially authorized for treatment of the cognitive impairment in Alzheimer's disease. Mood and behaviour disorder also have to be treated by both pharmacologic and nonpharmacologic strategies. Only pharmacologic treatments will be detailed here. The consensus statements established by this group of experts will be reevaluated each year, considering the new available data on Alzheimer's disease.

Aged↗
PubMed1997

Establishing the limits and characteristics of normal age-related cognitive decline.

BACKGROUND: Research into ageing-related pathology relies not only on exploration of disease aetiology, but also a clear understanding of the normal ageing process. The present study aims to examine the characteristics of elderly subjects who lie on the borderline between normal and pathological ageing. METHOD: Cognitive functioning is examined using computerized neuropsychometric assessment in a population of 833 normal elderly from which a cohort of 397 subjects with sub-clinical cognitive impairment are followed over three years. Subjects receive a standardized neurological examination and ApoE genotypes are established. RESULTS: Analysis of covariance revealed no cross-sectional age differences for syntax comprehension (p = 0.19), articulation (p = 0.46), semantic matching (p = 0.12), reading (p = 0.79), and implicit memory (p = 0.21) while explicit memory, language skills and visuospatial skills were found to deteriorate both in the cross-sectional age comparisons and across time. An overall intellectual ability factor, derived from Principal Components Analysis, was found by regression to decline principally in persons with low education, and a high initial IQ level was observed to provide a protective effect over age 75. Persons with higher levels of education show relative stability over time on language and secondary memory tasks but deteriorate as rapidly as persons with low education on visuospatial tasks. Five separate patterns of sub-clinical cognitive deficit were isolated by cluster analysis. Two groups, with differing clinical profiles (of which only one manifested the ApoE4 allele), were found to have an increased risk of developing senile dementia (OR = 4.4 and 3.9). A third group had a high prevalence of depressive illness, and the remaining two showed very little change. CONCLUSION: Ageing does not affect all cognitive functions uniformly: a high initial education level slowing rate of decline for certain tasks. Separate patterns of cognitive change are observed in early senile dementia, benign change and changes related to depressive illness. Results suggest the need for more stringent selection of normal control groups.

Age Factors↗
PubMed1996

Does education level determine the course of cognitive decline?

Many studies have implicated low education as a risk factor for cognitive impairment in elderly people. Findings are, however, inconsistent and the mechanism by which education level may intervene in senescent cognitive change is uncertain. The present study examines cognitive change over a 1-year period in 283 elderly persons manifesting recent subclinical deterioration in at least one area of cognitive functioning. The results suggest that the impact of both education level and young adult IQ on the degree of cognitive change over the year is greater in the older age groups. Secondary memory and language functions were found to be more resistant to decline in the high-education group, while attention, implicit memory and visuospatial skills are found to decline irrespective of education level.

Aged↗
PubMed1996

A typology of sub-clinical senescent cognitive disorder.

BACKGROUND: Cognitive impairment without dementia is commonly observed in ageing populations. The present study aims to describe types of impairment and evolution over a one-year period. METHOD: Three hundred and ninety-seven normal French elderly persons demonstrating recent, observable change in cognitive performance were examined annually using a computerised cognitive examination. RESULTS: Five subtypes were differentiated by cluster analysis. Two of the groups were predicted by logistic regression to be at high risk of senile dementia. Of 16 incident cases of senile dementia diagnosed in the following year, 13 were found to have derived from these two groups. The typology was also found to be useful in the description of age-associated memory impairment. CONCLUSIONS: Subclinical cognitive impairment was found to not constitute a unitary phenomenon and heterogeneous subgroups could be differentiated. The concept of 'normality' in elderly cohorts is reconsidered in the light of these findings.

Aged↗
PubMed1996

A comparison of subcutaneous sumatriptan and dihydroergotamine nasal spray in the acute treatment of migraine.

We compared the efficacy and safety of subcutaneous (SC) sumatriptan (6 mg) with that of dihydroergotamine (DHE) nasal spray (1 mg plus optional 1 mg) in the acute treatment of migraine. Two hundred sixty-six adult migraineurs (International Headache Society criteria) completed a multicenter, double-blind, double-dummy, cross-over study. Patients took SC sumatriptan for one attack and DHE nasal spray for the other in random order. Data from both treatment periods show that at all time points from 15 minutes, SC sumatriptan was significantly better than DHE nasal spray at providing both headache relief (moderate/severe headache improving to mild/none) and resolution of headache. Similarly, SC sumatriptan was superior to DHE nasal spray for the other efficacy end points assessed in the study. Patients reported that both treatments were well tolerated. Adverse events were reported by 43% of patients taking SC sumatriptan and 22% of patients taking DHE nasal spray. These were usually mild and transient. We conclude that subcutaneous sumatriptan has a faster onset of action than DHE nasal spray and provides greater relief of acute migraine symptoms.

Administration, Intranasal↗
PubMed1995

[Use of antidepressants in sleep disorders: practical considerations].

There is a general tendency to restrict the notion of sleep disorders to insomnia and consequently to limit treatment to the prescription of hypnotics. However, it is very often of benefit to prescribe psychotropic agents, in particular antidepressants, not only in insomnia but also in certain cases of hypersomnia, parasomnia and dysomnia associated with organic diseases. In some conditions, however, antidepressants may either induce or aggravate sleep disorders. This is the case with a number of psychostimulants that occasionally induce insomnia. It is also true of the tricyclic antidepressants, which may worsen or even induce a restlessleg syndrome that is often associated with periodic movement syndrome. On the other hand, the antidepressants may play a therapeutic role in certain sleep disorders : - depression-related insomnia is of course the << primary >> indication for antidepressants. Furthermore, certain antidepressants exhibit a sedative action resulting in a hypnogenic-type effect which appears well before the antidepressant effect; - the other types of insomnia may also often be treated with antidepressants : not acute reactional insomnia, against which hypnotics are remarkably effective, but chronic insomnia. In addition, all antidepressants may eventually correct depressive hypersomnia, but in these cases, it is evidently preferable to prescribe non-sedative drugs. Although some tricyclic antidepressants have been proposed for use in hypersomnia due to sleep apnea, their therapeutic interest is minor compared with mechanical and surgical treatment. In contrast, antidepressants play an important role in the treatment of narcolepsy, particularly for the correction of attacks of cataplexy. Antidepressants have also been used for some time in the treatment of parasomnia related to slow deep sleep (night terrors and sleepwalking), but the antidepressants may also be used in enuresis and in parasomnia related to REM sleep : nightmares, sleep paralysis, behavioral problems associated with REM sleep. Antidepressant (mainly serotoninergic drugs) are often used in the treatment of fibrolitis syndrome. Finally, antidepressants (particularly the serotoninergic antidepressants) play an important role in the drug treatment of fibromyalgia.

Antidepressive Agents↗
PubMed1992

Heterogeneity in senile dementia of the Alzheimer type: individual differences, progressive deterioration or clinical sub-types?

Although senile dementia of the Alzheimer type (SDAT) is commonly referred to as a disease involving global intellectual deterioration, clinical reports suggest the existence of variable patient profiles. A review of the clinical and biological research reporting heterogeneity in SDAT is summarized in terms of three descriptive models representing stage, compensation and sub-type hypotheses. Together the results suggest the existence of both quantitative and qualitative differences within a SDAT population. While the former may be partly attributable to the use in cross-sectional studies of persons at different stages of the disorder, qualitative differences in clinical evolution, variable patterns in regional cerebral blood flow, genetic markers and type of cognitive deficit strongly suggest the existence of different groups. This hypothesis requires verification by longitudinal neurological and psychometric studies of elderly persons with early dementia.

Aged↗
PubMed1992

Epileptic electroencephalographic abnormalities and developmental dysphasias: a study of 32 patients.

The relationships between severe developmental dysphasias and epilepsy were analysed in 32 patients with congenital dysphasias. The mean age was 8 years 2 months; 19 of 32 had never had seizures; 9 had had occasional seizures; 4 were epileptic. Twenty-two of 32 had normal repeated standard EEGs, but 10 (2 of which never had seizures) showed epileptic interictal discharges. During prolonged EEG after sleep deprivation, epileptic abnormalities were observed in 13 of the 32 cases (4 of which never had seizures). The overall night sleep recordings showed epileptic abnormalities in 30 of the 32 cases (17 of which had never had seizures). The epileptic interictal abnormalities varied considerably in intensity and aspect in the same patient from one examination to another. Developmentally aphasic children show a higher incidence of abnormal EEG than expected, particularly during overall night recordings. In most cases, the physiopathology of the language disturbance might be identical to that in Landau-Kleffner syndrome.

Adolescent↗
PubMed1991

Sleep organization and epilepsy.

Sleep is known to facilitate epileptic manifestations but can also protect the sleeper against the recurrence of seizures. This has been demonstrated in studies on sleep deprivation, and is particularly evident in alcoholic epilepsy and matutinal myoclonus epilepsy. Sleep organization in the epileptic patient is permanently altered by frequent awakenings and stage shifts. Nocturnal grand mal and repetitive partial seizures worsen the sleep disorder by reducing total sleep time and decreasing REM percentage by half. The cumulative effect of these sleep disorders may act on day-time vigilance in epileptics, and may even exert an influence on the recurrence of seizures.

Adult↗
PubMed1990

Initiation of carbamazepine therapy in partial epilepsy: a regional cerebral blood flow study.

The effect of the initiation of carbamazepine (CBZ) treatment on regional cerebral blood flow (rCBF) was studied using the intravenous Xenon technique in a group of epileptic patients suffering from complex partial seizures. A slight increase in mean rCBF (10.8 +/- 8.8%, P less than 0.01) was observed in 12 patients after the first month of CBZ treatment, while no rCBF change was found after 6 months of CBZ treatment. Regional analysis showed that the rCBF increase following 1 month of CBZ treatment involved all cortical regions with the exception of the right occipital region, irrespective of the initial value. Repeated rCBF measurements performed in normal volunteers (N = 6) and in epileptic patients (N = 10), chronically treated and not subjected to therapeutic modification, showed no significant change. The initial effect of CBZ on CBF found at the onset of the treatment but not after 4-6 months may be related to the improvement in epilepsy and in cerebral function (as suggested by cognitive findings).

Adolescent↗
PubMed1989

Interictal regional cerebral blood flow during non specific activation test in partial epilepsy.

In order to investigate, during activation testing, the interictal cortical cerebral blood flows (rCBF) of epileptic patients suffering from complex partial seizures, 40 epileptic patients (divided into "lesional", this is, with abnormal CT findings, and "non lesional", that is, with normal CT findings) were submitted to rCBF measurements with the 133 xenon intravenous technique, at rest and during intermittent light stimulation (ILS). The findings compared with normal volunteers seem to demonstrate that, during ILS, (1) in non lesional patients, the suspected epileptic focus shows a significant rCBF increase (2) in lesional patients, the significant rCBF increases were not in the region of the suspected epileptic focus but in adjacent or in contralateral ones. It was concluded that activation interictal rCBF measurements are more useful than resting ones for the determination of epileptic foci when CT findings are normal and that the nature of the epileptic focus influences markedly the interhemispheric activation pattern.

Adolescent↗
PubMed1987

Correlations between cerebral blood flow variations and clinical parameters in temporal lobe epilepsy: an interictal study.

Regional cerebral blood flow (rCBF) measurements were determined by the intravenous Xenon 133 technique in 80 patients suffering from temporal lobe epilepsy. All the patients had a normal CT scan. Three subgroups were differentiated, according to EEG and all-night polygraphic recordings: temporal lobe epilepsy with left (N = 25) or right (N = 25) EEG epileptic abnormalities and temporal lobe epilepsy with EEG abnormalities in both temporal regions with asynchronous occurrence (n = 30). In comparison with a control group (n = 20), there was (1) a marked reduction of blood flow in the temporal region corresponding to the site of the epileptic focus and (2) a reduction in blood flow in distant brain areas and the contralateral hemisphere. The rCBF decrease was highly correlated (p less than 0.001) with the disease severity (taking into account the complex partial seizure frequency and the number of secondary generalised seizures). Differences were found in the rCBF decrease between left and right temporal lobe epilepsy.

Adolescent↗
PubMed1987

[Gastro-esophageal reflux, personality study by the Minnesota Multiphasic Personality Inventory (MMPI)].

Gastro-esophageal reflux (GER) is often associated with other functional digestive manifestations. The subjectivity of these manifestations permits an in-depth study of the personality of these patients as compared to a regional reference population with the use of the Minnesota multiphasic personality inventory. In these patients suspected to have a gastro-esophageal reflux, the means to the scales are modified except for that of the psychopathy scale, which is reassuring considering its severity. However, no personality profile may be exteriorized. The difference between patients with GER certified or not by pH measurement rests on the predominance of neurotic scales in the group presenting a gastro-esophageal reflux certified by pH measurement. This results appears to be due to the disease itself rather than to the conditions of performance of the MMPI during pH measurement. Only a pre- and post-therapeutic study will enable to confirm these data.

Adult↗
PubMed1987

[Organization of sleep in recent temporal lobe epilepsy before and after treatment with carbamazepine].

Sleep in epileptic patients with complex partial seizures has been considered as being less well organized than in normal subjects. This study attempted to precise whether this disorganization could be related to the length of the disease and could be improved by carbamazepine treatment. The study was performed in 15 patients with recently diagnosed (less than 3 months) and untreated temporal lobe epilepsy. Neurologic examination and CT scan were normal. Patients did not present a generalized seizure in the preceding 48 hours and during the study. Nocturnal sleep polygraphic recordings were performed: 2 recordings before treatment and 2 others after one month of carbamazepine administration (800 mg/day). Before treatment sleep was characterized by a marked instability (increase in awakenings, shifts in sleep stages, waking after sleep onset, stage 1 duration) when compared to normal subjects. Carbamazepine treatment improved sleep stability. Our data support the hypothesis of another possible mechanism than the occurrence of seizures to explain the disorganization of sleep in temporal lobe epilepsy. On the other hand sleep instability could not be related to the length of the disease since it existed soon after its onset. Carbamazepine treatment improved sleep stability and this improvement could play a role in the therapeutic effect of the drug.

Adolescent↗