Biomedical subjects

J-F Dartigues

Publications and source records attributed to J-F Dartigues.

13 recordsLinked to original sources

PubMed2005

[Consensus statement on severe dementia].

Under the auspices of the French Society of Gerontology and Geriatrics, a multidisciplinary team including geriatritians, neurologists, epidemiologists, psychiatrists, pharmacologists and public health specialists developed a consensus on care for patients with severe dementia. They defined 21 recommendations for general practitioners, long-term care physicians and specialists based on knowledge available in 2005. At all stages of the disease, the objective of care is to improve as much as possible quality-of-life for the patient and his/her family, including a life project until the end of life. It is always possible to do something for these patients and their family: nutritional status, behavior disorders, and incapacities to deal with basic activities of daily life have to be taken in consideration. Resource allocation and proximity care have to be targeted. Research areas necessary to improve the care of patients with severe dementia has been selected.

Aged↗

PubMed2005

[Prescription of cholinesterase inhibitors in Alzheimer's disease in France in 2000-2001: an assessment of compliance with national guidelines for diagnosis and follow-up].

INTRODUCTION: Alzheimer's disease (AD) became a treatable disease about ten years ago when cholinesterase inhibitors (CI) became available. We conducted a national population-based study in France in order to describe patients taking CI in 2001, to compare the diagnostic procedures of AD and the drug prescriptions with the French National guidelines, and to analyze the follow-up procedures of the patients. METHODS: The study was carried out in nine regions of France between December 1st 2000 and February 28th 2001 and included 3510 patients with CI treatment prescribed by the physicians affiliated with the National Social Security Health Care Fund. RESULTS: We found that the diagnostic procedures and the prescriptions were in compliance with the national guidelines with more than 90 percent of patients referred to a specialist, brain imaging in 85 percent and a MMSE scored between 10 and 26 in more than 90 percent. However, patient follow-up was in compliance with the guidelines in only 50 percent of patients. CONCLUSION: Diagnostic procedures of AD and first prescription of CI seem to be adequate in France, but patient follow-up needs to be improved.

Adult↗

PubMed2005

[Methodological problems in clinical and epidemiological research on ageing].

A lot of methological difficulties interfere with the design and the interpretation of data analysis in clinical and epidemiological research on diseases related to ageing. The first one is that normal and pathological ageing are often strongly related, with blurred limits. The selection bias is particularly frequent, related to numerous health care resources, to premature death, to deny or refusals. Data collection is also particularly difficult, due to memory problems related to ageing and prolonged lag time between exposure of a given factor and interview, or related to the disease of interest itself (in particular, dementia). Multiple confounding factors are frequent, due to polypathology and polymedication, also interference between biological, psychological and sociological factors. Another difficulty is related to the insidious evolution of many chronic pathologies related to ageing which interfere with the direction of the causality between factors and disease.

Aged↗

PubMed2005

Use of the headache impact test (HIT-6) in general practice: relationship with quality of life and severity.

To assess the global impact of episodic headaches in patients consulting general practitioners (GPs) using the Headache Impact Test (HIT-6) questionnaire, and to compare this with measures of headache severity and quality of life. A total of 2802 patients consulting 349 GPs participated to this cross-sectional study. Data were collected on headache severity using the Migraine Severity (MIGSEV) scale, headache impact with the HIT-6 and quality of life with the Qualité de Vie et Migraine (QVM) questionnaire. Diagnosis was assigned retrospectively according to the International Headache Society criteria. The association between the HIT-6 scale and the other scales was determined from a Pearson's chi-square test, an analysis of variance and Spearman correlation coefficients. Patients (2537) provided exploitable data. Six percent of the sample had little impact, 14% moderate, 14% substantial and 66% severe impact. The HIT-6 scores were significantly different between diagnostic groups, being highest in the migraine group. The HIT-6 score were well correlated with headache severity and QVM score. The HIT-6 scale correlates, across different diagnostic groups of headache, with both headache severity and with quality of life.

Adult↗

PubMed2004

[Towards a prevention of dementia?].

Many studies have shown that high blood pressure and, to a lesser extent, other vascular risk factors could be the target of interventions aiming to reduce the incidence of dementia. Two large controlled trials have demonstrated that blood pressure lowering drugs have a significant effect on the risk of dementia including Alzheimer's disease. On another hand, large epidemiological studies have shown associations between different vascular factors and dementia. Overall, these data suggest that interventions aiming to reduce the level of vascular risk factors might prevent dementia. The expected benefit of these interventions could be estimated from data provided by epidemiological studies, but large population-based controlled studies are needed to demonstrate the efficacy of preventive interventions.

Age Factors↗

PubMed2004

[Normative data for the MMSE, the Benton visual retention test, the Isaacs's set test, the digit symbol substitution test and the Zazzo's cancellation task in subjects over the age 70: results from the PAQUID Study].

UNLABELLED: Introduction. The aim of this study was to produce norms for the Mini-Mental State Examination, the Benton visual retention test, Isaacs's set test, the digit symbol substitution test and Zazzo's cancellation task (short 8-line version), in elderly people. METHODS: Data was collected in a representative sample of 1780 subjects aged 70 years and older, followed-up for five years after inclusion in the PAQUID study. Only individuals who did not have characteristics likely to alter their cognitive performance were considered. RESULTS: Descriptive statistics (median, tenth percentile, first and third quartile) were used to define gender-, age- and education-specific norms. CONCLUSIONS: These norms can be used by clinicians to interpret a patient's performance on several widely used cognitive tests according to the scores obtained by individuals of the same age, gender and educational level.

Aged↗

PubMed2004

[Joint modeling of quantitative longitudinal data and censored survival time].

BACKGROUND: In epidemiology, we are often interested in the association between the evolution of a quantitative variable and the onset of an event. The aim of this paper is to present a joint model for the analysis of Gaussian repeated data and survival time. Such models allow, for example, to perform survival analysis when a time-dependent explanatory variable is measured intermittently, or to study the evolution of a quantitative marker conditionally to an event. METHODS: They are constructed by combining a mixed model for repeated Gaussian variables and a survival model which can be parametric or semi-parametric (Cox model). RESULTS: We discuss the hypotheses underlying the different joint models proposed in the literature and the necessary assumptions for maximum likelihood estimation. The interest of these methods is illustrated with a study of the natural history of dementia in a cohort of elderly persons.

Biometry↗

PubMed2004

Use and misuse of triptans in France: data from the GRIM2000 population survey.

The extent and nature of triptan use for headache relief has been evaluated in a large epidemiological survey in the French general population. Over 25 000 individuals were screened for headache and for triptan use. Of this sample, 290 triptan users were identified from whom extensive data on headache characteristics and healthcare resource consumption were obtained. The use of triptans is relatively infrequent, 0.2% in the general population, with only 7.5% of migraine sufferers using these drugs. The majority of triptan users were female (80%) and presented headache characteristics typical of migraine (80%). The remaining 20% of subjects were thus using triptans for headache types in which the utility of these drugs has not been demonstrated. Among migraineurs, triptan consumers reported more frequent and severe headaches than non-consumers, and reported a higher incidence of nausea and vomiting. The principal determinant of triptan prescription was consultation with a general practitioner (GP), which may itself have been triggered by the severity of the headaches. GPs, rather than specialists, are the primary prescribers of triptans in France.

Adult↗

PubMed2003

Subacute meningoencephalitis in a subset of patients with AD after Abeta42 immunization.

BACKGROUND: AD is characterized by cerebral deposition of beta-amyloid plaques with amyloid beta-peptide (Abeta) 42 as the major peptide constituent, along with neurofibrillary tangles and neuronal loss. In transgenic mice, active immunization against Abeta42 removes these plaques and improves cognitive function. A Phase I study in AD patients demonstrated good safety and tolerability of multiple injections of aggregated Abeta42 (AN1792) with QS-21 as adjuvant. METHODS: Three hundred seventy-two patients with mild to moderate AD were randomized to receive IM injections of AN1792 or placebo (4:1) at baseline and at months 1, 3, 6, 9, and 12 in a multicenter Phase II safety, tolerability, and pilot efficacy study. Dosing was terminated after four early reports of meningoencephalitis, but follow-up continued. The study remains blinded, and further results will be reported after its termination. RESULTS: Symptoms and laboratory findings consistent with meningoencephalitis occurred in 18 of 298 (6%) patients treated with AN1792 compared with 0 of 74 on placebo (p = 0.020). Sixteen of the 18 had received two doses, one had received one dose, and one had received three doses of the study drug before symptoms occurred. The median latency from the first and last injections to symptoms was 75 and 40 days. No case occurred later than 6 months after the first immunization. Anti-Abeta42 antibody titers were not correlated with the occurrence or severity of symptoms or relapses. Twelve patients recovered to or close to baseline within weeks, whereas six remain with disabling cognitive or neurologic sequelae. All 18 patients remain alive to date (December 31, 2002), 6 months to >1 year after symptom onset. CONCLUSIONS: Postvaccination meningoencephalitis occurred without clear relation to serum anti-Abeta42 antibody titers. Potential mechanisms such as T-cell and microglial activation may be responsible and are under consideration to develop a safer anti-Abeta immunotherapy for AD.

Adrenal Cortex Hormones↗

PubMed2003

Body mass index and incidence of dementia: the PAQUID study.

To study the relationship between body mass index (BMI) and risk of dementia, a cohort of 3,646 individuals aged > or =65 years living at home and without cognitive disorders at baseline were followed up for 8 years (the PAQUID [Personnes Agées Quid] Study). Subjects with a BMI < 21 had an increased risk of developing dementia as compared with subjects whose BMI was between 23 and 26 (odds ratio = 1.48, 95% CI = 1.08 to 2.04). However, when individuals who developed dementia early during the follow-up were excluded from the analysis, this relationship was no longer significant. A low BMI does not in itself seem to be a risk factor for dementia.

Aged↗

PubMed2003

Risk factors among elderly for short term deaths related to high levels of air pollution.

BACKGROUND: Air pollution has been linked to increased rates of mortality, but little is known about individual characteristics related to the increase in risk. AIMS: To examine short term effects of air pollution on daily mortality in elderly people in Bordeaux and compare characteristics of subjects > or =65 years old who died with levels of particulate air pollution. METHODS: Daily mortality data from Bordeaux were used to determine the core model of mortality for the period 1988-97. The air pollution indicator was regressed on the core model of mortality, allowing control of the main effect modifiers and confounding factors of air pollution on the same day. The residual series of this regression model was classified from the lowest to the highest to determine "low level days" and "high level days". A sample of 1469 elderly people in a French cohort study were studied. RESULTS: From 1988 to 1997, 543 subjects died; 55 deaths were during days with low air pollution and 51 during days with high air pollution. Only gender differed significantly according to both types of days, with a proportion of women significantly higher in high air pollution days than men. After adjustment for smoking habits, the odds ratio was 5.2 for women. CONCLUSION: The risk of mortality between women and men was determined on days with "high air pollution levels" above the 50-90th centiles compared to below the 10th centile. No clear pattern was observed between days with low levels of air pollution and the different centiles of exposure.

Aged↗

PubMed2003

[Prevalence of dementia and Alzheimer's disease among subjects aged 75 years or over: updated results of the PAQUID cohort].

The progression of the prevalence of dementia in developed countries will increase the difficulties of medical and psycho-social management of demented patients and their family. The aim of this study was to estimate the prevalence of dementia among subjects aged 75 years and over. These subjects have been followed-up ten years after the baseline examination of the PAQUID study, a prospective population-based cohort study on normal and pathological aging after 65 years. A total of 1,461 subjects, aged 75 years and over, have been visited. The prevalence of dementia was estimated to be at 17.8 p.cent. About 38.5 p.cent of these demented subjects ware living in an institution, which leads to the fact that more than the two thirds of the subjects living in an institution were demented persons. Alzheimer's disease was the main etiology of dementia (79.6 p.cent). Based on the French population census, currently there would be about 769,000 demented people aged 75 years or over in France. Dementia accounts for 72 p.cent of the potential need for the French subvention for dependent persons, called Allocation Personnalisee d'Autonomie P. These results point out the importance of regarding dementia as a Public Health priority and of developing necessary measures for caring for these subjects, whether residing in their home or an institution.

Activities of Daily Living↗

PubMed2002

A French cluster of Creutzfeldt-Jakob disease: a molecular analysis.

We report the molecular and phenotypic analysis of a French cluster of three cases of Creutzfeldt-Jakob disease (CJD), two of them occurring in 1998 in the same village and the other in 1995 in a neighboring village. Analyses of the occurrence of these events in a close area with less than 3000 inhabitants over the 1992-1999 notification period confirmed that they are rare. This could be explained either by a common source of contamination or by the coincidental occurrence of either sporadic or genetic CJD. We applied genetic analysis and brain PrPres typing to explore these CJD cases. The three patients did not carry any mutation in their prion protein gene coding sequence. All were homozygous for methionine at the polymorphic codon 129. Brain tissue was available from two cases that died in 1998. The two patients showed different PrPres profiles on Western blot and distinct clinico-pathological features. These findings do not support the conclusion that in these three cases, CJD was acquired from a unique source of contamination and suggest that concurrent occurrence of sporadic CJD accounted for this CJD cluster.

Aged↗