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Biomedical subjects

Jean-Pierre Clément

Publications and source records attributed to Jean-Pierre Clément.

16 recordsLinked to original sources
PubMed2006

Dementia patients caregivers quality of life: the PIXEL study.

BACKGROUND: Alzheimer's disease and related syndromes have heavy social and human consequences for the patient and his family. Beyond the neuropsychiatric effects of specific therapies for dementia, one of today's challenges is the quality of life for both patients and their informal caregivers. OBJECTIVES: This survey tends to determine parameters influencing caregivers' quality of life, and its possible link with patients' quality of life. METHODS: A scale measuring caregivers' quality of life, developed from data from previous PIXEL studies was used. It is a questionnaire composed of 20 items. The scale was related to the socio-demographic data of both patients and their main caregivers, to the ADRQL scale (Alzheimer Disease Related Quality Life) of Rabins for the QoL of dementia patients, to the patients medical and therapeutic data, specially a neuropsychological inventory: Folstein's cognition test, Cornell's depression scale, the fast battery of frontal assessment, Katz's dependence index, Cummings' neuropsychiatric inventory for behavioral and psychological symptoms of dementia and to a physician evaluation of caregiver's depression. RESULTS: One hundred patients diagnosed with dementia who live at home with their principal caregivers were recruited for this survey. Patients were 80.2 +/- 6.8 years old and caregivers were 65.7 +/- 12.8 years old. The caregivers' quality of life was correlated to the quality of life of the patients they cared for, the importance of behavioral disorders, and the duration of dementia evolution. Women caregivers had a worse quality of life and were more depressive than men. DISCUSSION: Caregivers' and patients' quality of life are related and both share a community of distress.

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PubMed2006

[The GPcog for detecting a population with a high risk of dementia].

GPcog is a screening tool for dementia in the aged. It consists of nine cognitive items and six items assessing the daily living instrumental activities by an informal carer. This study was aimed to assess the reliability of the French version of the GPcog in a psychogeriatric population. Two hundred and eighty inpatients from a short-term psychogeriatric ward, with or without dementia, were examined. Scores on GPcog, MMSE and on a five-word memory test for screening dementia were compared to the final diagnosis of dementia. The mean age of subjects was 77.8+/-7.0 years for males (n=116), and of 80.3+/-6.6 years for females (n=164). One hundred eighty two patients had dementia, mainly of Alzheimer's type, and 98 had psychiatric disorders but were non demented. GPcog sensitivity for the diagnosis of dementia was 96%, specificity 62%, positive predictive value 83% and negative predictive value 90%. GPcog is an accurate and well-accepted instrument for dementia screening in primary care. French results were similar to those obtained with the English version. It can be easily used by non-specialized carers.

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PubMed2006

[Psychiatric disorders in non demented elderly people].

Psychogeriatrics is a rapidly growing field. In France, the focus is currently on targeted education and specific management. Psychiatric disorders may be atypical in the elderly, and may also be difficult to distinguish from the effects of aging or somatic disorders. The principal disorders observed in old age are depression, late delusion, anxiety disorder, hysteria, delirium and mania. Depression has specific features, depressive equivalents, particular risk factors, and a categorical and dimensional therapeutic approach. Diagnosis and screening must be improved Late delusion is organized around a notion of injury, and is an active attempt to deal with isolation, depression and anxiety. The term "very late-onset schizophrenia-like psychosis" has been proposed. Anxiety also has specific features in the elderly and is intimately related to depression. If left untreated, the consequences can be severe. Hysteria is pathoplastic with time, age and educational status. Pseudocognitive conversions are starting to be seen in old age. Delirium is very frequent in the elderly; it is often multifactorial, but psychosocial factors must not be underestimated. Mania can also be provoked by somatic disease, and mixed syndromes are far from rare. Dementia can be approached from its psychopathological dimension, particularly in terms of psychosocial risk factors and protective factors relating to the individual's biography and personality. Thus, psychogeriatrics is an integrated medical discipline in which psychiatric disorders are approached through specific clinical management, oriented research and structured training.

Age Factors↗
PubMed2005

[A descriptive national survey of 166 Alzheimer health networks].

OBJECTIVE: Assess and describe the organization, operation, and aims of Alzheimer health networks in France. METHODS: Questionnaire sent by post or handed to physicians in France identified as involved in management of Alzheimer patients by Novartis Pharma sales representatives. RESULTS: 166 networks managing Alzheimer's disease (2/3 primarily gerontological and 1/3 specializing specifically in Alzheimer's). In 61.9% of the cases, the physician supervising the network was a hospital staff physician, often a geriatrician (48%). The other member physicians were essentially general practitioners. Several paramedics and social workers also participated. Most networks were organized as not-for-profit organizations. Financial support most often came from the relevant ministries and the health insurance funds. The number of active cases handled by the networks could not be globally assessed. The operating tools for the networks included membership charters, management guidelines and protocols, and shared medical files, but fewer than 30% of the networks used any one of these. The networks had as their primary objectives training and information, patient follow-up and gerontological coordination. These aims were consistent with the goals they felt that had come closest to attaining, i.e., improving the quality and organization of care, sharing information with and training other health professionals, and providing information to the public. Barely one third of the networks had developed an assessment procedure. Among the obstacles to network operations were the participants' lack of availability, the absence of collaboration between professionals, and financial problems. CONCLUSION: Despite the disparity in the quality and exhaustiveness of the data collected, our survey confirmed the diversity and dynamism, but also the lack of formal structure and the difficulties confronted by the Alzheimer networks in France.

Allied Health Personnel↗
PubMed2005

[Role of personality in depression of the elderly: difference between early and late life depression].

Personality disorders have been implicated in the occurrence of depression in the elderly. The main purpose of this study was to assess the role of personality disorders in depression of the elderly and to distinguish between early and late onset depression. The study included 48 subjects over 65 years of age from a department of psychiatry, who suffered from a major depressive episode according to the criteria of the DSM-III-R, without bipolar characteristics. The patients were examined at two different times. At the first interview, depression was assessed by the mini-GDS and the CES-D scales, and a cognitive disorder was ruled out by the Mini-Mental State Examination. The patients were then classified in two groups according to the time of the first occurrence of depression, before (early onset depression) or after (late onset depression) 65 years of age. A second evaluation was performed after the cure of the depression. The patients' personality was then assessed using the International Personality Disorder Examination, in its VKP French-translated version, which evaluates personality disorders as defined by the criteria of the DSM-III-R and the ICD-10. The frequency of personality disorders was higher in patients with early-onset depression rather than in those with late onset depression. The most frequent personality disorder was avoiding personality (Cluster C) according to categorical as well as dimensional assessment. "Dependant personality" (Cluster C) was also quite often associated with early-onset depression. However this results should be confirmed by a larger study.

Age of Onset↗
PubMed2005

[Vulnerability of caregivers for demented patients. The Pixel study].

UNLABELLED: Caregivers of demented outpatients can have a weak health, are often old and alone, and the burden of care can generate precariousness. OBJECTIVES: This survey tends to determine the parameters influencing the caregiver's Quality of Life (QoL) and precariousness, and to measure their consequences. METHODS: A scale measuring caregivers' QoL and a scale measuring precariousness, developed from data of previous PIXEL studies were used. Each scale is a 20-item questionnaire. The results were related to the socio-demographic data of both patients and their principal caregivers, and to the patients' medical and therapeutic data. RESULTS: 1.410 patients diagnosed with dementia who lived at home with their principal caregivers were included in this survey. The caregivers' QoL was correlated to the carers' precariousness. Females caregivers had poorer QoL and more precariousness than men. Caregivers' QoL and precariousness were favourably influenced by specific dementia treatment. Frail caregivers had a poor QoL and an important precariousness. They were often sick and had to deal with nutritional difficulties with the demented patient. They were less satisfied with their care ability and their relationships with their patients. DISCUSSION: Caregivers' QoL and precariousness are related and both express their distress. The specific treatment of dementia is beneficial for both of them. Presumably, this benefit would be increased by supportive care of carer and patient.

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PubMed2005

[post-traumatic stress disorder in the elderly].

Diagnosis of post traumatic stress disorder (PTSD) requires a past history of psychic traumatism and characteristic psychotraumatic symptoms like re-experiencing of the traumatic event, avoidance of stimuli associated with the traumatic event and increased arousal. In the elderly, PTSD prevalence rate is about 0.9% after 60 years of age. Clinical features are almost identical to those observed in younger patients. However there are various types of PTSD: PTSD de novo, occurring after exposure to extreme trauma in old age; chronic PTSD when symptoms persist since the time of the trauma; delayed-onset PTSD when patients exhibit signs of the disorder decades after the trauma; complex PTSD, generated by exposure to repeated traumatisms in early development, who could be linked up to changes in personality in older exposed to repeated traumatisms. Pharmacological and psychotherapic interventions used in younger populations can be applied for treatment to older adults, when taking into account the pharmacodynamic and psychic changes associated with aging.

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PubMed2004

[Depression in the elderly patient].

Depression is the most usual mental disorder in the elderly, but underdiagnosed and undertreated. Its prevalence is variable and depends on type and severity of episode. Nevertheless, even subsyndromic depression needs to be correctly treated. Depressive symptomatology observed in the elderly is often similar to adult presentation, but it can be masked and difficult to recognise. The different clinical features are described with underlining their particularities. Secondary depressions are also evoked with individualisation of "vascular" depression and its etiopathogenic hypotheses in relationship with observations given by cerebral neuro-imagery. Risk factors of depression in old age are known, but recent studies have reviewed some of them, particularly by distinguishing late onset depression and early onset depression. According to therapeutic response and prognosis, it appears necessary to better discriminate them. Risk of dementia after depression seems to be related with type of depressive episode and with the treatment efficacy. Finally, the problem of detection of depression in old age is discussed with a suggestion to use assessment instruments as the mini-GDS in all medical practices, to optimise diagnosis and management.

Age of Onset↗
PubMed2004

Reasons of informal caregivers for institutionalizing dementia patients previously living at home: the Pixel study.

CONTEXT: Study of the problems and requirements of the main caregiver providing home care for dementia patients that have resulted in the patient being institutionalised. OBJECTIVES: To determine the reasons for placing the dementia patient in an institution. RESOURCES: Self-administered questionnaire of 48 questions on the patient and caregiver, including a list of complaints, given to the main caregiver. Medical questionnaire on the patient filled in by the geriatrician. RESULTS: Data were collected from 109 questionnaires concerning 75 females with dementia (84.7 +/- 6.7 years) and 34 demented males (80.8 +/- 7.4 years). In two-thirds of cases the main caregiver was a female, aged 61.1 +/- 12.1 years. Cognitive disorders were not the main reasons for institutionalizing patients. The most frequent caregiver complaint at the time of institutionalisation was incontinence, followed by withdrawal. The caregiver's main problem resulting in institutionalisation was dependence, with behavioural disorders in second place. A treatment with anticholinesterase for dementia was associated with a live-in career being provided for 20 months longer than in the case of patients not receiving this treatment. Statistical analysis revealed 6 groups of separate caregiver-patient situations. On the one hand there were those patients who appeared to be easy for the caregiver to cope with: those with no problems, docile patients and passive patients not opposing care. In these cases the caregiver was most often young and male, or not directly related to the patient. On the other hand there were 3 other groups: patients with inappropriate motor behaviours, violent/agitated patients and unmotivated patients who opposed care. These patients lived with an elderly caregiver who had been looking after the patient for several years. DISCUSSION: Caregivers' requirements are for help with coping with and preventing dependence. The caregiver suffers terribly from a lack of relief, particularly when young. CONCLUSION: It is necessary to change the focus of home care for dementia patients towards preventing loss of autonomy and its consequences and to allow for periods of relief for home caregivers.

Adaptation, Psychological↗
PubMed2004

[Depression in the elderly; future prospects].

Extensive research has been achieved on the old age depression during the last decades. Specific clinical features and management have been reported. Indirect clinical and behavioural indicators, and even biological ones should be considered for the detection of depression. Cognitive assessment must be promoted in standard practice to differentiate depression from incipient dementia, but also in depression occurring in long stay care, vascular depression and in the depression-executive dysfunction syndrome. Distinction between recurrent depressive episode and late-onset depression has to be clarified. Therapeutic strategies have to be reconsidered in duration, according to the trend toward chronicity of late life depression. They remain based on the use of pluri-aminergic antidepressants. Depressive disorder in the elderly is associated with hippocampus dysfunction, but other biological variables should be taken into account according to a dynamic stress-vulnerability model.

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PubMed2003

[Life events, personality and dementia].

Etiopathogeny of dementia is presently considered as multidimensional, involving genetic, biological and psychological factors. This study was aimed to find out if life events and personality are risk factors for dementia and varied according to the type of dementia. 54 subjects meeting the DSM IV criteria for dementia were included and compared to 54 cognitively controls. 25 patients had dementia of Alzheimer type, 17 frontotemporal dementia and 12 vascular dementia. Data collection was performed using various questionnaires filled in by the patients and caregivers: questionnaire EVVIE for life events, the French version of the personality traits (VKP) for the assessment of personality, a questionnaire for diagnosing alexithymia (EFEA), the mini-geriatric depression scale for depression, and the Neuropsychiatric Inventory for behavioural disorders. Cognitive function was assessed by the Mini Mental State Examination, and the Global Deterioration Scale. Significant differences were found between people suffering from dementia and controls for the frequency and impact of several life events occurred during childhood, marital or professional life. Some qualitative but no quantitative differences in life events experienced were found between patients with different types of dementia. People suffering from dementia had significant personality traits higher than controls such as passivity, avoidance, obsessive features and alexithymia. However, no difference was found in personality traits between subjects with the different types of dementia. These results suggest that psychosocial cumulative stress and personality could constitute a risk factor for dementia, which could be mediated by a dysregulation in the HPA axis.

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PubMed2002

Complaints of informal caregivers providing home care for dementia patients: the Pixel study.

CONTEXT: Prospective study of the complaints, problems and requirements of the main caregiver providing home care for dementia patients. OBJECTIVES: To determine the complaints of home caregivers, how they are interrelated and what causes them. RESOURCES: Self-administered questionnaire of 42 questions on the patient and caregiver, including a list of complaints, given to the main caregiver. Medical questionnaire on the patient filled in by the attending physician, usually a specialist, freelance or salaried doctor. RESULTS: 408 sets of records were compiled, concerning 236 demented women (77.1 +/- 0.47 years) and 172 demented men (75.7 +/- 0.57 years). In two-thirds of cases, the main caregiver was a woman aged 60.6 +/- 0.79 years. Female caregivers were more vulnerable than male caregivers. The most frequent caregiver complaint, regardless of the stage of the disease, concerned loss of motivation and withdrawal. The patient's awareness of the disorder was accompanied by a reduction in motor dysfunction and aggressiveness, but associated with a higher frequency of the complaint regarding loss of motivation reported by the caregiver. The caregivers' problems concerned mainly the absence of relief and the impossibility of having any time to themselves. Caregivers' requests for information concerned medical information, care structures and day care facilities. DISCUSSION: The attending physician comes into close contact with the patient, but must take into account the patient's environment. The physician can provides a separate analysis to the caregiver and does not completely answer to certain family questions or needs. He or she is not the family's prime source of information. The caregivers' requirements relate to the areas that are the attending physician's responsibility: the development and characteristics of the disease. The caregiver is anxious about the patient's future and is trapped by his or her involvement in the care, suffering greatly from the lack of relief. CONCLUSIONS: It is necessary to change the focus of home care for dementia patients to fit the context in which they live and to allow for periods of relief for home caregivers.

Aged↗